肱踝脉搏波传导速度与小血管阻塞型脑卒中的相关性研究

Correlation between brachial ankle pulse wave velocity and cerebral apoplexy with small vascular obstruction

目的探讨肱踝脉搏波传导速度(ba PWV)与缺血性脑卒中不同亚型之间的相关性及特点,为缺血性脑卒中患者的预防与治疗提供理论依据。方法本研究依托"北方农村地区居民常见慢性非传染病疾病家系队列研究",选取2013-2015年房山区脑卒中队列患者中缺血性脑卒中患者279名,进行问卷调查、体格检查、生化指标检测、ba PWV和颈动脉内膜中层厚度测量,根据不同缺血性脑卒中TOAST(急性卒中Org10172治疗试验)分型的亚型将患者分为大动脉粥样硬化(LAA)型脑卒中组和小血管阻塞(SAO)型脑卒中组。用R语言1.0.142软件进行t检验、χ~2检验和Z检验,用logistic回归模型分析TOAST分型各亚型与ba PWV之间的关系。结果 LAA型脑卒中患者的收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、颈动脉内膜中层厚度和中心性肥胖率均显著高于SAO型脑卒中患者,HDL-C、ba PWV、ba PWV异常率均显著低于SAO型脑卒中患者,差异均有统计学意义(P<0.01)。多元logistic回归分析结果显示,在调整了年龄、性别、血压是否正常等因素之后,SAO型脑卒中患者ba PWV异常的风险是LAA型脑卒中患者的2.747倍(OR=2.747,95%CI:1.500~6.118,P<0.05);在调整了年龄、颈动脉内膜中层厚度、心脑血管疾病病史及低密度脂蛋白胆固醇后,SAO型脑卒中患者ba PWV异常的风险是LAA型脑卒中患者的1.542倍(OR=1.542,95%CI:1.051~2.242,P<0.05)。结论缺血性脑卒中TOAST分型不同亚型间ba PWV存在差异,相比于LAA型脑卒中患者,SAO型脑卒中患者肱踝脉搏波传导速度异常的风险更高。

Objective To explore the correlation between different subtypes of ischemic stroke and brachial ankle pulse wave velocity（ba PWV）, and to provide the basis for preventing and treating the ischemic stroke. Methods On the basis of the family cohort study of common chronic non-communicable diseases in residents of the rural areas in the north part of China, 279 patients with ischemic stroke were selected from the cohort study in Fangshan District as the subjects. The investigation was performed with the questionnaire, physical examination, biochemical test, ba PWV and carotid intima thickness measurement. According to the types of ＂Org10172 treatment test for acute stroke（TOAST）＂, the ischemic stroke patients were divided into the large arterial atherosclerosis（LAA） subgroup and small arterial occlusion（SAO） subgroup. The t test, χ2 test and Z test were used to analyze the data, the used software was R language1.0.142. The relationship between TOAST subtypes and ba PWV was analyzed by logistic regression model. Results The systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol, carotid intima-media thickness and central obesity rate in the LAA subgroup were significantly higher than those in the SAO subgroup（P〈0.01）, but the HDL-C, ba PWV and ba PWV anomaly rate in the LAA subgroup were significantly lower than those in the SAO subgroup（P〈0.01）. Multivariate logistic regression analysis showed that after adjusting the age, gender and blood pressure factors, the risk of ba PWV abnormality in patients with SAO type stroke was 2.747 times higher than that in patients with LAA stroke（OR=2.747, 95%CI： 1.500-6.118, P〈0.05）; after adjusting the age, carotid intima-media thickness,cardiovascular disease history and low-density lipoprotein cholesterol factors, the risk of ba PWV abnormality in patients with SAO type stroke was 1.542 times higher than that in patients with LAA type stroke（OR =1.542, 95% CI： 1.051-2.242, P 0.05）.Conclusion There was a significant difference of ba PWV between different subtypes of ischemic stroke patients according to TOAST classification. As compared to patients with LAA type stroke, the abnormal ba PWV was correlated more closely to SAO stroke in patients with SAO type stroke.