踝臂脉搏波传导速度对高血压患者早期舒张功能不全的预测价值

Value of brachial-ankle pulse wave velocity in predicting the early mild diastolic heart failure in patients with hypertension

目的:评价踝臂脉搏波传导速度(baPWV)对高血压患者早期轻度舒张功能不全(DHF)的诊断价值。方法:根据诊断标准,选择高血压伴轻度左室DHF患者40例(HT-DHF组)和与其年龄匹配的健康人群32例(对照组),以及有高血压但无DHF患者44例(HT组)。测量所有研究对象的baPWV,同时测定体质指数(BMI)、脉压(PP)、脑钠肽(BNP)和心脏超声指标。结果:HT-DHF组有血脂异常、糖尿病患者的数量及BMI与HT组比较,均差异有统计学意义(均P<0.05)。HT-DHF组baPWV、PP、左室重量指数(LVMI)、BNP、左房内径、二尖瓣舒张早期血流充盈速度峰值(E)与二尖瓣舒张晚期血流充盈速度峰值(A)的比值(E/A)与HT组及对照组比较,均差异有统计学意义(均P<0.05),其中baPWV与PP、LVMI、BNP、E/A、E与二尖瓣环的间隔面和(或)侧壁面运动速率峰值(E')的比值(E/E')、早期二尖瓣减速时间有较好的相关性,而与左室射血分数、左室舒张末内径、左室收缩末内径无关。ROC曲线面积表明,当baPWV≥1 504 cm/s时,诊断DHF的敏感性75%,特异性73%。结论:baPWV是一种能反映传统危险因素的综合指标,能为早期发现高血压患者DHF提供依据,同时也为降压药物疗效的监测提供依据。

Objective：To assess the value of brachial-ankle pulse wave velocity（baPWV） in diagnosing the early stage of diastolic heart failure（DHF） in essential hypertension.Method：According to diagnosis standard,40 patients with hypertension and DHF（HT-DHF group）,44 patients with hypertension but without DHF（HT group）,and other 32 healthy volunteers with suited age（control group） were selected respectively.The baPWV,body mass index（BMI）,pulse pressure（PP）,brain natriuretic peptide（BNP） and echocardiographic parameters were recorded.Result：There were significant differences in the numbers of high lipid and diabetic patients and BMI in HT-DHF group compared to HT group（P0.05）.The baPWV,PP,left ventricular mass index（LVMI）,BNP,left atria diameter,the ratio of mitral early diastole filling velocity peak to mitral late diastole filling velocity peak（E/A） in HT-DHF group were significantly different with those in HT group and control group（P0.05）.The baPWV was correlated with PP,LVMI,BNP,deceleration time,the ratio of early mitral valve flow velocity to early tissue Doppler lengthening velocity（E/E′）,but uncorrelated with left ventricular ejection fraction,left ventricular end-diastolic diameter,left ventricular end-systolic diameter.The under area of ROC curve demonstrated that when the value of baPWV≥1 504 cm/s,the sensitivity of diagnosing the early mild DHF was 75% and specificity was 73%.Conclusion：The baPWV is a integrated indicator to reflect the traditional risk factors,and it may be efficient to diagnose the early mild DHF,at the same time it can also provide the evidence to assess the curative effect of anti-hypertensive drugs.