超极速脉搏波技术定量评估早期高血压患者颈动脉弹性衰退的临床应用价值

Effect of early hypertensive patients on carotid elastic recession quantified with ultrafast pulse wave velocity

目的 探讨超极速脉搏波(ufPWV)技术定量评估早期高血压患者颈动脉弹性衰退的临床应用价值。方法 纳入2018年5月—2019年2月于我院门诊及入院的共90例连续的高血压受试者(高血压组),依据血压水平将高血压组分为高血压1组和高血压2组;另将同期体检的健康志愿者66名纳入研究作为正常组。利用二维超声测量颈动脉内膜中层厚度(cIMT),再利用ufPWV技术测量收缩早期脉搏波速度(PWV-BS)及收缩末期脉搏波速度(PWV-ES)。以cIMT 0.05 cm为诊断内中膜增厚的阈值,将正常组及高血压1组及高血压2组均进一步分为A组(cIMT≤0.05 cm)、B组(cIMT>0.05 cm)2个亚组,正常组有62例(正常组A亚组),高血压1组有11例(高血压1组A亚组)及高血压2组有8例(高血压2组A亚组)。利用Pearson’s相关性分析探讨3组cIMT、PWV-BS及PWV-ES的变化趋势及各自与年龄的相关性,并比较cIMT在正常范围(≤0.05 cm)时3组中PWV-BS及PWV-ES的差异以评估PWV-BS及PWV-ES诊断效能。结果 高血压1组、高血压2组与正常组颈动脉弹性参数cIMT、PWV-BS及PWV-ES比较差异有统计学意义(均P<0.05),并且高血压2组cIMT、PWV-BS及PWV-ES均高于高血压1组及正常组,高血压2组与高血压1组PWV-ES比较差异有统计学意义(P<0.05),cIMT、PWV-BS比较差异无统计学意义(P>0.05)。颈动脉弹性参数与年龄的相关性分析显示,正常组及高血压1组PWV-ES(r=0.693,P<0.001;r=0.618,P<0.001)与年龄相关性显著优于PWV-BS(r=0.377,P=0.006;r=0.474,P<0.001)及cIMT(r=0.417,P<0.001;r=0.423,P=0.001),高血压2组PWV-ES(r=0.872,P<0.001)与年龄相关性显著优于cIMT(r=0.486,P=0.003),高血压2组PWV-BS与年龄无明显相关(P=0.133)。颈动脉弹性参数PWV-ES与年龄的单因素回归分析显示,正常组(β=0.089,P<0.001)与高血压1组(β=0.105,P<0.001)及高血压2组(β=0.118,P<0.001)两两相互比较,其上升趋势依次显著增高。高血压1组及2组中A亚组分别与正常组A亚组PWV-BS及PWV-ES比较,差异均有统计学意义(均P<0.05)。结论 ufPWV技术可捕获到cIMT增厚前的动脉弹性改变,可作为定量评估早期高血压患者颈动脉弹性改变的一种简便、无创方法。

Objective To explore the clinical application value of ultrafast pulse wave velocity(ufPWV)technology in quantitative evaluation of carotid elastic recession in early hypertensive patients.Methods 66 patients in the normal control group and 90 patients in the hypertension group were detected.The hypertension group was divided into hypertension group 1 and hypertension group 2 according to the blood pressure level.Carotid intima-media thickness(cIMT)was measured by two dimension ultrasound,and pulse wave velocity of beginning systole(PWV-BS)and pulse wave velocity of end systole(PWV-ES)were measured by ufPWV technique.cIMT 0.05cm was used as the threshold for the diagnosis of medial and middle membrane thickening,the normal group and the hypertension group 1 and 2 were further divided into two subgroups:Group A(cIMT≤0.05cm)and Group B(cIMT>0.05cm).Pearson's correlation analysis was used to investigate the variation trend of cIMT,PWV-BS and PWV-ES in these three groups and their correlation with age,and to compare the differences of PWV-BS and PWV-ES in these three groups when cIMT was in the normal range(≤0.05cm).Results There were significant differences in age,body mass index,low density lipoprotein,high density lipoprotein,triglyceride and other parameters between the normal group and the hypertension group(all P<0.05).The cIMT,PWV-BS and PWV-ES of hypertensive group 2 were higher than those of hypertensive group 1 and normal group.There were significant differences in Carotid elastic parameters cIMT and PWV-BS and PWV-ES in hypertension group 1,hypertension group 2 and normal group(all P<0.05).Among them,hypertension group 2>hypertension group 1>normal group.In the comparison of three parameters between hypertension group 2 and hypertension group 1,there were significant differences in PWV-ES(P<0.05),but no significant differences in cIMT and PWV-BS(P>0.05).The correlation between PWV-ES(r=0.693,P<0.001;r=0.618,P<0.001)and age was significantly better than correlation between PWV-BS(r=0.377,P=0.006;r=0.474,P<0.001)and cIMT(r=0.417,P<0.001;r=0.423,P=0.001)and age in normal group and hypertension group 1.The correlation between PWV-ES(r=0.872,P<0.001)and age was significantly better than that between cIMT(r=0.486,P=0.003)and age,while there was no significant correlation between PWV-BS and age in hypertension group 2(P=0.133).The regression analysis of carotid elastic parameters PWV-ES and age showed that the upward trend increased significantly orderly in the comparison between the normal group(β=0.089,P<0.001)and the hypertension group(β=0.105,P<0.001)and the hypertension group(β=0.118,P<0.001).When cIMT≤0.05cm,there were 62 cases in normal group(normal group A),11 cases in hypertensive group 1(hypertensive group 1 group A)and 8 cases in hypertensive group 2(hypertensive group 2 group A).PWV-BS and PWV-ES in hypertensive group 1 and group 2 were significantly different from those in normal group A(all P<0.05).Conclusion The ufPWV technique can capture the changes in arterial elasticity before the thickening of cIMT,and it can be used as a simple and non-invasive method to quantitatively evaluate the changes in carotid artery elasticity in patients with early hypertension.