脉动波传导速度在外周血管病预测和诊断中的意义

Pulse wave velocity a sensitive predicator for peripheral artery disease among diabetic patients

目的探讨脉动波传导速度在预测和诊断外周血管病（PAD）中的意义。方法对国内15个医疗中心，1500例50岁以上2型糖尿病，具有一项或多项心血管疾病相关危险因素的患者，一期同时测定踝肱指数（ABI）和臂踝脉动波传导速度（baPWV）。所有患者同时记录血压水平，高血压病程；血糖水平，糖化血红蛋白值，糖尿病病程；血脂水平；体质量指数；吸烟状况；心血管事件和脑血管病的患病情况。对数据进行统计分析。结果2型糖尿病患者在ABI值正常时，baPWV表现为异常加速，且女性较男性更明显（P〈0．01）。2型糖尿病患者合并PAD后，ABI降低（右侧0．82±0．15，左侧0．80±0．16），baPWV和非合并PAD患者相比明显减速[右侧（1652．6±428．7）cm／s比（1699．1±316．3）cm／s，左倾4（1655．3±477．2）cm／s比（1677．5±338．6）cm／s，P〈0．01]。ABI、baPWV和年龄、糖尿病病程、高血压等危险因素以及心血管事件间均呈正相关。年龄是PAD的重要危险因素，非PAD患者，baPWV随年龄增大而加速（P〈0．01），PAD患者的baPWV则随年龄增加而明显减低（P〈0．01）。结论baPWV可以和ABI一起作为PAD筛查和诊断的指标，可能会比ABI更早、更敏感地预测血管病变的存在和发生。

Objective To investigate the role of pulse wave velocity on he predication and diagnosis for peripheral artery diseases among diabetic patients. Methods Ankle-brachial index （ABI） and brachial- ankle pulse wave velocity （baPWV） were detected simultaneously in 1500 type 2 diabetic patients which over 50 years old with one or more risk factors. Results baPWV speeded up in enrolled diabetic patients when ABI showed normal ; and more faster in female patients compared with males （ male vs. female： right, 1647.0±347.7 vs. 1714.1±338.0; left, 1638.1 ±368.0 vs. 1708.4 ±355.5, P〈0.01）. Compared with diabetic patients with PAD vs non-PAD, ABI was less than 0. 9, baPWV slowed falling down [ right, ABI： 0. 82 ±0. 15, baPWV： （ 1652. 6 ±428.7） cm/s vs. （ 1699. 1 ±316. 3） cm/s; left, ABI： 0. 80 ± 0. 16, baPWV ： （ 1655.3 ± 477.2） cm/s vs. （ 1677.5 ± 338. 6） cm/s, P 〈 0. 01 ] ABI and baPWV showed a consistently positive relationship with aging （OR = 0. 17, 0. 33, P 〈 0. 01 ）, diabetes （OR =0. 07, 0. 17, P 〈 0. 01 ） , hypertension （ OR = 0. 18, 0. 39, P 〈 0. 01 ） , and rate of ischemic heart disease （ OR = 0. 25, 0. 10, P 〈0. 01 ）. Aging was an important risk factor for PAD. For diabetic patients with PAD, baPWV was stepped down with aging （ per-decade up ： 1681.6 ± 545.9, 1678.2 ± 494.9, 1598. 5 ± 417.1, 1493. 9 ± 444. 8, P 〈0. 01 ）. For those without PAD, baPWV was expedited with aging （ every 10-age-up： 1570. 0 ± 337.8, 1707.7±356.4, 1829.0±378.0, 1955.6±430.5, P〈0.01）. Conclusions In type2 diabetic patients, baPWV shows abnormal even when ABI was normal. When these patients combine with PAD, baPWV slows down, and the phenomena is related with the severity of PAD. These data implicate baPWV could act as a screen and diagnosis factor for PAD as ABI did, and might be a more sensitive alarming predicator for artery lesions.