高血压合并主动脉夹层患者的动脉弹性功能变化及其临床意义

Artery Elastic Property and Its Clinical Significance in Aortic Dissection Patients with Essential Hypertension

目的探讨高血压合并主动脉夹层患者脉搏波传导速度(PWV)的变化及其临床意义。方法经症状、CT血管造影(CTA)确诊的高血压合并急性主动脉夹层患者22人(主动脉夹层组),平均发病时间为9.6h,患者均有高血压史,入院平均血压为(180±16)/(97±9)mmHg,其中DebakeyⅠ型9例、Ⅱ型6例、Ⅲ型7例。入院后维持血压在140/80mmHg左右,于24h内血压控制稳定后分别测定上肢动脉段(C-R)、主动脉段(C-F)、下肢动脉段(F-A)的PWV。选择高血压患者22例作为对照组,同样测定上述动脉段的PWV。比较两组患者各动脉段PWV的变化和主动脉夹层患者不同类型之间各动脉段PWV的差别。结果主动脉夹层组患者的主动脉段PWV显著低于高血压对照组[夹层组RC-F(8.14±0.78)比高血压(9.64±1.79)m/s;夹层组LC-F(8.16±1.85)比高血压(9.38±1.56)m/s],左上肢颈桡动脉段PWV显著低于高血压对照组(夹层组LC-R(8.42±1.84)比高血压(9.01±2.13)m/s,P<0.05],其余动脉段两组之间无显著性差别。亚组分析表明,对主动脉段PWV来说,三亚型之间均有显著性差别,其中Ⅰ型主动脉夹层患者最低,Ⅱ型最高,Ⅲ型居中[RC-F,Ⅰ型:(8.04±1.89),Ⅱ型:(8.77±0.78),Ⅲ型:(8.36±1.86)m/s;LC-F,Ⅰ型:(8.10±1.56),Ⅱ型:(8.64±1.85),Ⅲ型:(8.38±1.86)m/s,P<0.05];左上肢动脉段PWVⅠ型主动脉夹层显著低于部Ⅱ、Ⅲ型[Ⅰ型:(8.11±1.15),Ⅱ型:(8.35±2.81),Ⅲ型:(8.64±1.86)m/s,P<0.05],而Ⅱ、Ⅲ型之间无显著性差别。结论主动脉夹层患者的主动脉PWV显著降低,累及的主动脉段越长,PWV越低。因此PWV检查有助于主动脉夹层的诊断和预后判断。

Objective This study was designed to investigate the changes of pulse wave velocity （PWV） and its clinical significance in aortic dissection（AD） patients with hypertension. Methods Twenty-two aortic dissection patients with hypertension were confirmed by clinical data, computed tomography with contrast angiography. Patients were classified as DeBakey Ⅰ type （n=9）, DeBakey Ⅱ type （n=6）, and Ⅲ type （n=7）. Twenty-two patients matched age and blood pressure served as control group. The PWV of carotid to radial artery （C-R）, carotid to femoral artery （C-F） and femoral to ankle artery （F-A） of both side were measured within 24 hours after admis sion when their blood pressure were controlled at about 140/80 mmHg. Results The PWV of C-F segments of both sides and LC-R in AD patients were significantly lower than control group [Rcr （8.14 ±0.78）m/s vs control （9.64±1.79）, LCF（8. 16±1. 85） vs control（9. 38±1. 56）m/s, LCR（8. 42±1. 84） vs control （9. 01±2. 13）m/s, all P〈0.05）. DeBakey subtypes analysis indicated the C-F PWV of DeBakey Ⅰ was the smallest and DeBakey Ⅱ the biggest[RC-F type Ⅰ： （ 8.04 ± 1.89 ）, type Ⅱ ： （ 8.77 ± 0.78 ）, type Ⅲ ： （ 8.36 ± 1.86 ） m/s; LCF type Ⅰ ： （8.10±1.56）, type Ⅱ： （8.64±1.85）, type Ⅲ： （8.38±1. 861m/s, P〈0.05]. The PWV of lefe CR in DeBakey Ⅰ subgroup was significantly lower than DeBakey Ⅱ and DeBakey Ⅲ subgroup [type Ⅰ： （8.11 ± 1. 15）, type Ⅱ ： （8.35±2.81）, type Ⅲ： （8.64±1. 861m/s, P〈0.05], but the PWV of Degakey Ⅱ and Ⅲ were not significantly different. Conclusions The PWV of carotid to femoral artery in aortic dissection patients, which include aortic artery and iliac artery, was significantly decreased. The longer the artery segment was injured, the lower PWV was found. Pulses wave velocity examination is helpful to the diagnosis and prognosis of aortic dissection.