300例高血压前期者脉搏波传导速度与颈动脉硬化改变及相关性

The Change and Correlation Between Pulse Wave Velocity and Carotid Atherosclerosis in 300 Prehypertensive People

目的探讨高血压前期人群大动脉顺应性和颈动脉硬化的情况及相关性。方法分层随机抽取高血压前期、高血压、正常血压各300例作为研究对象。采用动脉硬化诊断装置VP-1000测定肱踝脉搏波传导速度和踝臂指数,多普勒彩色超声观察颈总动脉内膜-中膜厚度以及斑块形成情况,比较三组间差异。比较各血压组合并颈动脉斑块时脉搏波传导速度的变化情况,分析颈动脉内膜-中膜厚度与脉搏波传导速度的相关性。结果(1)随着血压从正常向高血压转变,肱踝脉搏波传导速度呈上升趋势,高血压前期组(1390±171cm/s)较正常血压组(1293±151cm/s)升高但低于高血压组(1652±291cm/s,P<0.01);踝臂指数高血压前期组(1.115±0.060)与正常血压组(1.114±0.061)相比差异无统计学意义(P>0.05),但在高血压组明显升高(1.132±0.067,P<0.01)。(2)颈动脉内膜-中膜厚度增厚率及斑块发生率在高血压前期组与正常血压组相比差异均无统计学意义,但在高血压组显著升高(P<0.01);颈总动脉内膜-中膜厚度在高血压前期组(0.73±0.10mm)与正常血压组(0.72±0.12mm)相比差异无统计学意义(P>0.05),但在高血压组显著增厚(0.78±0.16mm,P<0.01)。(3)有或无合并颈动脉斑块时,高血压前期组脉搏波传导速度均较正常血压组升高(P<0.01),但低于高血压组(P<0.01);各血压组合并颈动脉斑块时脉搏波传导速度较无颈动脉斑块时均升高(P<0.01)。肱踝脉搏波传导速度与颈总动脉内膜-中膜厚度呈正相关(r=0.271,P<0.01),校正血压因素后相关性仍存在(r=0.156,P<0.01)。结论高血压前期肱踝脉搏波传导速度显著升高,提示存在早期动脉硬度改变。肱踝脉搏波传导速度与颈动脉内膜-中膜厚度呈正相关,肱踝脉搏波传导速度可作为评估高血压前期动脉硬度有效且简便易行的指标。

Aim To observe the change of large arterial compliance and carotid atherosclerosis,explore the correlation between them in prehypertensive people.Methods 300 subjects each with prehypertension,high and normal blood pressue were selected randomly,and brachial-ankle pulse wave velocity （BaPWV）,ankle-brachial index （ABI）,carotid arteries intima media thickness （IMT） and plaque were observed.Results （1）BaPWV accelerates as the blood pressure elevate,prehypertensive group（1 390±171 cm/s） increased than in the normal group（1 293±151 cm/s,P〈0.01）,lower than the hypertensive group（（1 652±291 cm/s,P〈0.01）;ABI in prehypertensive group（1.115±0.060） compared with normal blood pressure（1.114±0.061） had no difference,lower than in hypertensive group （1.132±0.067,P〈0.01）.（2） IMT thickening and plaque rate in prehypertension group compared with normal blood pressure group showed no statistical difference,but lower than the hypertensive group （P〈0.01）.Carotid common arteries IMT （CCA-IMT） in prehypertension（0.73±0.10 mm）and normal blood pressure group（0.72±0.12 mm）had no statistical difference,which were significantly thickened in high blood pressure group（0.78±0.16 mm,P〈0.01）.（3）PWV in people with carotid plaque increased than normal controls,in each subgroup （P〈0.01）.BaPWV was positively related to CCA-IMT（r=0.271,P〈0.01）,after adjustment of blood pressure the correlation still exists（r=0.156,P〈0.01）.Conclusion In prehypertension,arterial stiffness indicator BaPWV significantly increased,suggesting the existence of early arterial stiffness changes. BaPWV was positively correlated with carotid artery IMT, suggesting BaPWV can be simple and effective assessment indicator of arterial stiffness for prehypertension.