脉搏波速度、踝臂指数和颈动脉粥样硬化与不同高海拔地区急性脑梗死关系的探讨

Change of carotid atherosclerosis,pulse wave velocity and ankle-brachial index in acute cerebral infarction at various high altitudes

目的探讨脉搏波速度(pulse wave velocity,PWV)、踝臂指数(ankle-brachial index,ABI)和颈动脉粥样硬化(carotid atherosclerosis,CAS)与不同高海拔地区急性脑梗死(acute cerebral ischemic,ACI)的关系。方法选取高海拔地区(海拔3 400 m以上)50例为高海拔ACI组,中高海拔西宁地区(海拔2 260 m)50例为中高海拔ACI组,应用PWV自动测量臂踝脉搏波速度(baPWN)和ABI。采用颈动脉超声仪检测颈动脉内膜中层厚度(IMT)、收缩期峰期血流速度(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)及颈动脉粥样硬化斑块的检出情况。结果高海拔ACI组斑块检出率86.0%(43/50)明显高于中高海拔ACI组60.0%(30/50)。两组软斑的检出率明显增高,高海拔地区更加显著。高海拔ACI组IMT、baPWV值明显高于中高海拔组(P<0.01)。而ABI显著低于中高海拔组(P<0.01)。颈动脉内膜狭窄程度与baPWV显著正相关(r=0.641,P<0.01),与ABI呈显著负相关性(r=-0.198,P<0.05)。调整年龄、性别、BMI等其他危险因素后,多元回归提示只有IMT、baPWV和ABI是高原地区ACI独立因素(P<0.01,P<0.01或P<0.05)。结论ABI和PWN与CAS和高原地区ACI发生密切相关。高海拔、低氧和低气压等高原地理环境和特殊饮食习惯可能引起ACI患者血管僵硬度增加,颈动脉内膜狭窄程度增高和欠稳定性斑块的形成。

Objective To study the relevance of pulse wave velocity（PWV）, ankle-brachial index（ABI） and carotid atherosclerosis with acute cerebral infarction（ACI） at various high altitudes. Methods Two groups of subieets from the Qinghai-Tibetau Plateau were collected： 50 patients of ACI at high altitude of 3 400 m above sea level; 50 patients of ACI at middle altitude of 2 260 m sea level. The carotid intimal medial thickness （IMT）, position and stability of plaques were measured by color Doppler ultrasonography technique. The brachial-ankle pulse wave velocity （baPWV） and ABI were measured using a volume plethymograph. Results Patients with ACI of high altitude 86.0% （43/50） had higher ratio for carotid plaques than that of middle altitude 56.0 % （30/50）, especially soft plaque. IMT of ACI was significantly increased with altitudes （ P 〈0.01）, baPWV was high and ABI was low in ACI of high altitude as compared with ACI of middle altitude. After other risk factors were adjusted,IMT was significantly correlated with baPWV and ABI （ r =0. 641,-0. 198; P〈0.01 or 〈0.05）. Conclusion ACI is closely correlated to baPWV, ABI and carotid atherosclerosis. The results suggest the serious environment stresses （altitude and hypoxia） and food habits at high altitude may increase the risk of ACI.