脉搏波传导速度(PWV)在体质综合评价中的应用

Application of Pulse Wave Velocity in Integrated Physical Fitness Evaluation

目的:基于脉搏波传导速度(PWV)与血压、超重和肥胖等形态、机能指标相关性研究,探讨PWV在体质综合评价中的应用价值。方法:回顾性研究,在常规体质检测基础上,测量4下文522例普通居民肱踝脉搏波传导速度(baPWV)评价动脉僵硬度。主要处理方法:1)通过血压各指标对baPWV评价的动脉硬化受试者工作(ROC)曲线、高血压和动脉硬化阳性率一致性Kappa检验等分析血压和baPWV相关性;2)logistic逐步回归(校正年龄、性别、高血压)分析超重、肥胖与baPWV关系,根据ROC曲线计算BMI预测动脉硬化的最佳切点。结果:1)江苏人群男性baPWV均值为1 383±237 cm/s,女性1 278±246 cm/s;baP-WV随着年龄增加而增高;2)高血压、正常高值血压人群的baPWV均高于正常人;控制年龄和性别因素,收缩压、舒张压、脉压与PWV均呈显著正相关,动脉硬化ROC曲线均有较好的预测价值,P<0.001;但是高血压和动脉硬化阳性诊断一致性检验Kappa系数=0.402,以高血压的诊断标准区分人群预测动脉硬化灵敏度只有36%,特异度较高为97.8%;3)超重、肥胖人群baPWV、动脉硬化发生率均显著高于正常者,P<0.001;校正年龄、性别、血压因素后,超重和肥胖人群动脉硬化OR值分别为1.58和2.1;BMI预测动脉硬化的最佳切点为24.25,此时灵敏度为67.2%,特异度为57.2%。结论:1)baPWV随着年龄增加而增高,且男性高于女性;2)血压指标预测PWV评价的动脉硬化有较高价值,但高血压标准区分人群将漏诊很大部分血压正常、动脉僵硬度却异常者,单纯使用血压指标不能理想地适用于普通人群血管病变的早期风险评估。超重、肥胖人群baPWV和动脉硬化风险显著高于正常者,BMI预测动脉硬化最佳切点为24.25,进一步验证了以24作为BMI超重切点适应性较好;3)PWV和血压等指标一起引入综合体质测评体系有利于对普通人群进行心血管疾病早期风险评估及干预,提高体质测评与健康关联性。

Objective：To explore the value of pulse wave velocity（PWV） in integrated physical fitness evaluation.Methods：4522 common residents in Nanjing city were surveyed,and all objects were tested in terms of common indexes of physical fitness and arterial stiffness evaluated by brachial-ankle PWV（baPWV）.The study included correlation analysis of the association between baPWV and blood pressure,BMI using receiver operator characteristic（ROC） curve and Kappa test of the positive rate for hypertension and arteriosclerosis and calculation of the optimal cut-off points of BMI for predicting atheroscleross.Results：1） BaPWV increases with the age increasing;Mean baPWV of Nanjing residents is 1383±237cm/s for men and in 1278±246cm/s for women.2） Systolic blood pressure,diastolic blood pressure,pulse pressure were positively correlated with baPWV and has good predictive value（P0.001）;Kappa test of positive rate for hypertension and arteriosclerosis showed low consistency and the sensitivity of hypertension to predict atherosclerosis was 36%.3） Compared with normal group,overweight and obesity residents has significant difference in baPWV and prevalence of arteriosclerosis（P0.001）;the odds ratio values of overweight and obese population for predicting hypertension are 1.58 and 2.1 with adjusted age.The optimal cut-off point of BMI for evaluating atherosclerosis is 24.25.Conclusions：1） BaPWV increases with the age increasing and shows lower level in women.2） Blood pressure shows a good value to predict atherosclerosis,however,the consistency for positive rate of hypertension and arteriosclerosis is low.It indicates that the diagnostic criteria of hypertension are not suitable for assessing the risk of early atherosclerosis.BaPWV in overweight and obese population is higher than the normal group.3） The integrated evaluation System including baPWV and blood pressure will be of benefits to risk assessment and early intervention for cardiovascular diseases.