健康人不同部位脉搏波传导速度、反射波增强指数之间的相关性及影响因素

Associations and related factors between pulse wave velocity and arterial system and augmentation index measured on different sites in a healthy population

目的 研究颈-股动脉脉搏波传导速度（CF-PWV）、颈-桡动脉脉搏波传导速度（CR-PWV）、颈-踝动脉脉搏波传导速度（CA-PWV）以及反射波增强指数（AI）之间的相关性及影响因素.方法 一项北京市海淀、大兴区社区人群调查研究,样本数5116名,从中筛选出健康者729名（男413名,女316名）,年龄17～85岁,平均年龄（39.2±12.2）岁.采用自动PWV分析仪（Complior）测定不同部位PWV,采用桡动脉压力波分析仪（SphygmoCor,Sydney,Australia）测定AI.结果 简单、偏相关分析都显示各动脉节段PWV之间显著相关（均P＜0.01）.简单相关分析AI与CR-PWV之间没有相关性（r=-0.072,P=0.053）.偏相关分析AI与CR-PWV、CA-PWV间都没有相关性（r=0.024,P=0.528;r=0.068,P=0.070）.多因素逐步回归分析显示：CF-PWV与年龄、收缩压和心率呈正相关,与女性呈负相关（R^2=0.249）.CR-PWV与舒张压呈正相关,与年龄和女性呈负相关（R2=0.155）.CA-PWV与收缩压和年龄呈正相关,与脉压和女性呈负相关（R2=0.244）.AI与年龄、舒张压、LDL-C和女性呈正相关,与心率、身高和血肌酐水平呈负相关（R2=0.536）.结论 CA-PWV包含颈-股动脉节段,在一定程度上可替代CF-PWV作为大动脉僵硬度的指标.CR-PWV主要反映周围肌性动脉的僵硬度,与CF-PWV、CA-PWV不可相互替代.不同的血压组分（收缩压、舒张压和脉压）对CF-PWV、CA-PWV、CR-PWV有不同的影响.AI的影响因素较多,且与PWV的相关性较差,并不适合作为评价动脉僵硬度的敏感、可靠指标.

Objective To explore the associations and related factors between pulse wave velocity （PWV） and arterial system and augmentation index （AI） measured on different sites in a healthy population. Methods All subjects were selected from a local community investigation study which included 5116 people living in Haidian District or Daxing District, Beijing, China. A total of 729 healthy subjects [age 17-85 years, mean （39.2 ± 12.2 ）years, 413 men] were included in this study. Carotid-femoral pulse wave velocity （ CF-PWV）, carotid-radial pulse wave velocity （CR-PWV） and carotid-ankle pulse wave velocity （CA-PWV） were measured using Complior. Pulse wave analysis at the right radial artery was measured and AI was calculated using SphygmoCor device. Results CF-PWV correlated significantly with CR-PWV or CA-PWV （all P 〈0. 01 ） by both Pearson and Partial Correlation analysis adjusted by age,body mass index, waist-hip ratio, systolic blood pressure, diastolic pressure and heart rate. There was no significant correlation between AI and CR-PWV （r = -0. 072, P = 0. 053 ） and between AI and CR-PWV （ r = 0. 024, P = 0. 528 ）, AI and CA-PWV （ r = 0. 068, P = 0. 070 ） while AI was significantly correlated with CF-PWV （ r = 0. 110, P = 0. 003 ）. Multiple stepwise regression analyses showed that age, systolic blood pressure and heart rate were positively while female gender was negatively correlated with CF-PWV. CRPWV was positively correlated with diastolic blood pressure and negatively correlated with pulse pressure and female gender （R2 =0. 155）. CA-PWV was positively correlated with systolic blood pressure and age while negatively correlated with pulse pressure and female gender. Multiple stepwise regression analysis also demonstrated that AI was positively correlated with age, diastolic blood pressure, low density lipoprotein cholesterol and female gender, and negatively correlated with heart rate, height and serum creatinine level （R^2 = 0. 536）. Conclusions CA-PWV, covering carotid-femoral arterial segment, could partially represent CF-PWV as an indicator of large arterial stiffness. CR-PWV mainly reflects peripheral muscular arterial stiffness and is not suitable to be used interchangeably with CF-PWV or CA-PWV. Component of blood pressure （systolic, diastolic or pulse pressure） may have different influences on CF-PWV, CA-PWV or CRPWV. AI is affected by multiple factors and poorly correlated with PWV and is not a good indicator for arterial stiffness.