下肢动脉粥样硬化闭塞症患者颈动脉僵硬度改变与左心室舒张功能关系的超声评价

Evaluation of the association between carotid arterial stiffness and left ventricular diastolic function in patients with lower limb extremity atherosclerosis obliterans using ultrusonography

目的应用超声技术评价下肢动脉粥样硬化闭塞症（AS）患者左侧颈动脉僵硬度改变与左室舒张功能的关系。方法①32例AS患者及34例健康志愿者，应用超声射频信号动脉僵硬度分析（quality arterial stiffness，QAS）技术分析其颈动脉僵硬度参数：扩张性系数（CC）、扩张性（DC）、僵硬度参数（α、β）和脉搏波传导速度（PWVβ）。②二维超声心动图及组织多普勒技术测量左室结构和功能参数：舒张末期室间隔厚度（IVSd）、舒张末期左室内径（LVDd）、舒张末期左室后壁厚度（PWd）、左室射血分数（EF）、二尖瓣环收缩期峰值速度（s′）、二尖瓣环舒张早期峰值速度（e′）、Tei指数、二尖瓣舒张早期血流峰速E与二尖瓣环舒张早期峰值速度e′比值（E／e′）。将上述参数进行比较并与颈动脉僵硬度参数进行相关分析。结果①AS组DC、CC低于对照组，α、β、PWVβ高于对照组，差异有统计学意义（P〈0．05）；②AS组IVSd、PWd大于对照组，s′、e′低于对照组，Tei指数、E／e′高于对照组，差异有统计学意义（P〈0．05）。EF两组间差异无统计学意义（P〉0．05）；③e′与DC、CC呈正相关（r=0．39、0．36，P〈0．01），与α、β和PWVB呈负相关（r=-0．42、-0．42、-0．49，P〈0．01）；Tei指数与DC、CC呈负相关（r=-0．50、-0．52，P〈0．01），与α、β和PWVβ呈正相关（r=0．58、0．58、0．62，P〈0．01）；E／e′与CC呈负相关（r=-0．27，P〈0．05），与PWVβ呈正相关（r=0．28，P〈0．05）。s′、EF与颈动脉僵硬度参数均无明显相关（P〉0．05）。结论下肢动脉粥样硬化闭塞症时左侧颈动脉僵硬度增加，左室收缩及舒张功能受损；颈动脉僵硬度与左室舒张功能存在相关性，动脉僵硬程度能反映左室舒张功能的变化。

Objective To evaluate the association between the left carotid arterial stiffness and left ventricular diastolic function in patients with lower extremity atherosclerosis （AS）. Methods ①A total of 32 patients with AS and 34 control objects were enrolled. The carotid arterial stiffness parameters： compliance coefficient （CC）,distensibility coefficient （DC）,stiffness parameter （α,β）,pulse wave velocity β （PWVβ） were measured by using quality arterial stiffness（QAS） technology. And the values were compared between the two groups. ②The parameters of left ventricular （LV） structure and function：LV end-diastolic interventricular septal thickness （IVSd）,LV end-diastolic diameter （LVDd）, LV end-diastolic wall thickness （PWd）, LV ejection fraction （EF）, systolic velocity（s′）, early-diastolic velocity （e′）, Tei index and E/e′ ratio were measured by using two-dimensional echocardiography and tissue Doppler. These parameters were compared between the two groups. The association between the carotid arterial stiffness parameters and LV function parameters were analyzed by correlative analysis. Results ①Compared with the control group,the DC and CC were lower, and α,β PWVβ, IMT were higer than the control group, with statistically significant differences（ P 〈0.05）. ②The IVSd,Tei index and E/e′was significantly higher in the AS group than thosein the control group. And the PWd,s′ ,e′ were lower than those in the control group （ P 〈0.05）. There was no significant difference in EF between the two groups （ P〈0.05）. ③The er was eorrelated positively with DC and CC （ r = 0. 39,0.36, P 〈0.01） ,and negatively withα,β and PWVβ （ r = - 0.42, - 0.42, - 0.49, P 〈0. 01）. Tel index was correlated negatively with DC and CC （r = -0. 50, -0.52, P 〈 0. 01 ）, and positively with α,β , and PWVβ （ r = 0. 58,0.58,0.62, P 〈0.01）. The E/e′ was correlated regatively with CC （ r = - 0. 27, P 〈0. 05） ,and positively with PWVβ （ r = 0. 28, P 〈0. 05）. There were no significant correlation between s′, EF and the stiffness parameters of carotid artery （ P〉0.05）. Conelusions In patients with AS, the left carotid artery stiffness increases and left ventricular systolic and diastolic function are impaired. The carotid artery stiffness and left ventricular diastolic function is correlated. Changes in carotid artery stiffness reflect the change in left ventricular diastolic function.