肱-踝脉搏波传导速度与老年心血管病危险因素关系的研究

Association of Braehial-ankle pulse wave velocity with cardiovascular disease in the elderly

目的探讨肱．踝脉搏波传导速度（baPWV）与心血管病危险因素的关系，为临床早期检测动脉硬化提供新途径。方法选择2010年11月至2011年10月于我院体检或住院的老年人共348例作为研究对象，其中男232例，女116例；平均年龄（74．5±9．0）岁。所有对象均接受问卷调查，记录病史，并测定baPWV，同时测量身高、体质量、腰围、甘油三酯（．TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）等指标。比较危险因素与baPWV的关系。结果（1）心血管危险因素数量越多，baPWV升高发生率越高。（2）多因素Logistic回归分析显示：年龄（OR=5．223，95％CI：3．606～7．564）、LDL—C升高（OR=4．554，95％CI：2．413～8．593）、吸烟（OR=6．007，95％CI：3．775～9．560）、肥胖（OR=3．019，95％CI：2．363～3．857）、高血压（OR=6．938，95％CI：3．591-13．404）、高盐饮食（OR=2．555，95％CI：2．108～3．096）是baPWV升高的独立危险因素（P均〈0．05）；运动（OR=0．941，95％C10．915～0．967）、睡眠（OR=0．947，95％C10．927～0．968）是baPWV升高的保护因素（P均〈0．05）。（3）按照运动时间将健康组分为运动组（运动时间≥1h／d）和少运动组（运动时间〈1h／d），按照是否失眠分失眠组和无失眠组，发现运动组的baPWV值明显低于少运动组[分别为：（1169．0±34．8）、（1370．0±51．7）cm／s，t=2．719，P=0．012]，无失眠组的baPWV值明显低于失眠组[分别为：（1205．0±29．4）、（1358．0±36．2）cm／s，t=2.561，P=0．017]，差异有统计学意义。（4）老年单纯高血压组baPWV为（1852．0±46．7）cm／s、糖尿病组baPWV为（1693．0±38．2）cm／s、冠心病组baPWV为（1729．04-40．4）crrds，较健康组[baPWV为（1356．0±31．3）cm／s]高，差异均有统计学意义（P均〈0．05）。但单纯高血压组和高血压合并脑梗死组、单纯冠心病组和冠心病心肌梗死组baPWV差异均无统计学意义。结论（1）年龄、LDL—C升高、吸烟、肥胖、高血压、高盐饮食是baPWV升高的独立危险因素；运动、良好的睡眠是baPWV升高的保护性因素。（2）baPWV检测可做为发现早期动脉僵硬度增高的手段之一。

Objective To investigate the relationship between atherosclerosis and cardiovascular risk factors in the elderly, thus to provide new method for detection of atherosclerosis in the elderly. Methods From November 2010 to October 2011,348 elderly who addmitted to or had physical examination in our hospital were recruited in the study. All participants were interviewed through questionnaire, and medical history was recorded, Brachial-ankle pulse wave velocity （baPWV） was measured. Simultaneously, height, body weight, waist circumferrence, triglyceride （ TG ）, total cholesterol （ TC ）, high density lipoprotein-cholesterol （ HDL-C ）, low density lipoprotein-cholesterol （LDL-C）were measured. The association between baPWV and cardiovascular and atherosclerosis was investigated. Results The incidence of higher baPWV was increasing a＇s the number of risk factors of cardio vascular disease adding. Logistic regression analysis show that： Age （ OR = 5. 223,95% CI 3. 606 -7. 564） ,LDL-C（ OR = 4. 554,95% CI 2. 413 - 8. 593 ）, Smoking （ OR = 6. 007,95% CI 3. 775 - 9. 560）, Obesity （ OR = 3. 019,95% CI 2. 363 - 3. 857 ）, Hypertension （ OR = 6. 938,95% CI 3. 591 - 13.404 ）, High-salt diet（ OR = 2. 555,95% CI 2. 108 - 3. 096 ） were independent risk factors of baPWV incrdase （ P 〈 0. 05）; Exercise and good sleep were the protective factors for baPWV increasing. BaPWV levels were significantly lower in the exercise group（ exercise time 〉 1 h/d）than in the few exercise group（ exercise time 〈 1 h/d） （t = 2. 719, P = 0. 012）, and lower in good sleep group participants than in insomnia participants （t = 2. 561 ,P = 0. 017 ）（ P 〈 0. 05 ）. BaPWV, levels were significantly higher_in the group with essential hypertension （ 1852. 0 ± 46.7 cm/s）, with Type 2 Diabetes Mellitus （ 1693.0± 38.2 cm/s）, with coronary heart disease （ 1729. 0 ± 40.4 cm/s） than in the healthy group （ 1356.0 ±31.3 cm/s） （ P 〈0. 05 ）. There was no statistical difference between the essential hypertension＇ group and the hypertension complicated with cerebral infarction group, as well as between the coronary heart disease group and the myocardial infarction group. Conclusion Age, LDL-C increasing, smoking, obesity, hypertension and high-salt diet were independent risk factors of baPWV increase ; Exercise and good sleep were protective factors. BaPWV could be one of the methods for early detection of atherosclerosis.