大动脉炎患者动脉僵硬度影响因素的研究

Influencing factors of arterial stiffness in patients with Takayasu arteritis

目的大动脉炎患者动脉僵硬度增加,而动脉僵硬度增加是心血管事件的独立预测因素。本研究以臂踝动脉脉搏波传导速度(baPWV)为动脉僵硬度检测手段,旨在研究大动脉炎患者动脉僵硬度的相关影响因素。方法纳入2009-2016年就诊于阜外医院的大动脉炎患者177例,对其进行baPWV的测定,baPWV≥1400 cm/s认为存在动脉僵硬,并进一步研究baPWV的影响因素。结果合并动脉僵硬组患者有74例,其年龄、病程、体质量指数(BMI)、高血压、血脂异常、三酰甘油、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白、收缩压、舒张压、平均动脉压、心率及踝臂血压指数(ABI)>1.4的比例明显高于非动脉僵硬组(均P<0.05)。不同受累类型患者动脉僵硬发生率差异有统计学意义(P=0.006),Ⅴ型受累动脉僵硬比例最高。多因素分析显示:年龄(B=7.247,P=0.003)、病程(B=8.285,P=0.027)、血脂异常(B=112.890,P=0.037)、Ⅴ型受累(B=168.214,P=0.001)、平均动脉压(B=7.339,P<0.001)是baPWV的独立影响因素。经激素治疗后临床稳定的患者,baPWV与治疗前相比差异无统计学意义[1342(1102~1502)比1346(1099~1720) cm/s,P=0.576]。结论年龄、病程、血脂异常、Ⅴ型受累和平均动脉压升高是影响大动脉炎患者动脉僵硬度的危险因素。

Objective It has been established that patients with Takayasu arteritis(TA) were associated with increased arterial stiffness, and increased arterial stiffness was an independent predictor of cardiovascular morbidity and mortality in general population. In this research, the correlation between clinical parameters and arterial stiffness measured by brachial-ankle pulse wave velocity(baPWV) was investigated in TA patients. Methods One hundred and seventy-seven patients who took baPWV measurement in Fuwai Hospital between 2009 and 2016 were included in this study. BaPWV value≥1400 cm/s was defined as arterial stiffness. The clinical parameters correlated with baPWV were further analyzed. Results A total of 74 patients had increased arterial stiffness. Patients with increased arterial stiffness were older and had longer disease duration, more prevalence of hypertension, hyperlipemia and abnormal ankle brachial index. Patients with increased arterial stiffness also had higher level of body mass index(BMI), triglycerides, total cholesterol, low density lipoprotein-cholesterol(LDL-C), C-reactive protein, systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial blood pressure(MAP) and heart rate(all P<0.05). The incidence of increased arterial stiffness was significantly different among different angiographic types(P=0.006). Patients with type Ⅴ were with the highest rate of increased arterial stiffness. Multivariate linear regression demonstrated that age(B=7.247, P=0.003), disease duration(B=8.285, P=0.027), dyslipidemia(B=112.890, P=0.037), type Ⅴ(B=168.214, P=0.001) and MAP(B=7.339,P<0.001) were influencing factors of baPWV. BaPWV levels of patients in the active stage didn’t significantly improve after conversion into the remission stage with glucocorticoids [1342(1102-1502) vs 1346(1099-1720) cm/s, P=0.576]. Conclusion Age, disease duration, hyperlipidemia, type Ⅴ and higher MAP are risk factors of arterial stiffness in TA patients.