脉搏波传导速度与缺血性脑血管病危险因素的相关性分析

Correlation analysis between pulse wave velocity and the risk factors of ischemic cerebrovascular disease

目的探讨脉搏波传导速度与缺血性脑血管病危险因素的关系。方法缺血性脑血管病患者共510例,来自2014年11月2016年1月上海交通大学附属第六人民医院中医科住院患者,其中男182例,年龄3586岁;女328例,年龄3686岁。取其双侧肱-踝脉搏波传导速度（ba PWV）的平均值,分为ba PWV正常组（ba PWV<1400 cm/s,n=138）和异常组（ba PWV≥1400 cm/s,n=372）。分析其与缺血性脑血管病患者体重指数（BMI）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、空腹血糖（FBG）、餐后2 h血糖（2h PBG）、糖化血红蛋白(Hb A1c)、空腹胰岛素（Ins0min）,血肌酐（Cr）、血尿酸（UA）、同型半胱氨酸（Hcy）、纤维蛋白原（FIB）、D-二聚体、超敏C反应蛋白（hs-CRP）、收缩压（SBP）、舒张压（DBP）、脉压（PP）及高血压病史、糖尿病史、颈动脉粥样硬化斑块等危险因素的相关性。结果 ba PWV异常组与正常组在年龄、SBP、DBP、PP、TC、LDL、FBG、2h PBG、Hb A1c及高血压病史、糖尿病病史、颈动脉硬化斑块患病率等方面比较,差异有统计学意义（P<0.05）;单变量Logistic回归分析显示年龄（OR=3.144）、SBP（OR=10.057）、DBP（OR=2.849）、PP（OR=7.772）、Hb A1c（OR=2.172）、高血压病史（OR=10.355）、糖尿病史（OR=2.224）、颈动脉斑块（OR=1.650）是影响ba PWV增快的危险因素;对以上有意义的变量进行多变量逐步回归分析,结果示年龄（OR=3.638）、SBP（OR=2.885）、高血压病史（OR=3.582）是ba PWV异常的独立危险因素。结论 ba PWV与年龄、收缩压、高血压病史密切相关。应积极控制血压,降低脉搏波传导速度,改善动脉僵硬度,减少缺血性卒中发生的风险。ba PWV对临床上评估缺血性脑血管病患者动脉硬化程度有重要的指导意义。

Objective To explore the relationship between pulse wave velocity and the risk factors of ischemic cerebrovascular disease(ICVD). Methods The double brachial-ankles pulse wave velocity(ba PWV) were measured in 510 cases with ICVD(male: 182 cases, 35-86 years old; female: 328 cases, 36-86 years old), who were admitted to Department of Traditional Chinese Medicine of the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from November 2014 to January 2016. According to the average ba PWV of double sides, they were divided into two groups,ba PWV normal group(ba PWV<1400 cm/s, n = 138) and abnormal group(ba PWV≥1400 cm/s, n = 372). The correlation was analyzed between ba PWV and the age, sex, body mass index(BMI), fasting blood glucose(FBG), postprandialplasma blood glucose(2h PBG), glycosylated hemoglobin(Hb A_(1c)), total cholesterol(TC), triglyceride(TG), high density lipoprotein(HDL), low density lipoprotein(LDL),serum creatinine(Cr), blood uric acid(UA), homocysteine(Hcy), D-dimer, fibrinogen(FIB), high-sensitivity C-reactive protein(hs-CRP), systolic blood pressure(SBP), diastolic blood pressure(DBP), pulse pressure(PP), hypertension, diabetes and carotid atherosclerotic(CAS) plaque. Results The statistical differences could be indicated by comparing the abnormal ba PWV group and the normal ba PWV group in age, SBP, DBP, PP, TC, LDL, FBG, 2hP BG, HbA_(1c), hypertension, diabetes and CAS plaque(P <0.05). The result of Logistic regression analysis demonstrated that age(OR = 3.144), SBP(OR = 10.057), DBP(OR =2.849), PP(OR = 7.772), HbA_(1c)(OR = 2.172), hypertension(OR = 10.355), diabetes(OR = 2.224) and CAS plaque(OR = 1.650) were the risk factors of ba PWV, and age(OR = 3.638), SBP(OR = 2.885), hypertension(OR = 3.582) were independent risk factors of ba PWV anomalies. Conclusion ba PWV is positively correlated with age, systolic blood pressure and medical history of hypertension. To reduce ischemic stroke risk, we should actively control blood pressure,decelerate the pulse wave velocity and improve arterial stiffness. ba PWV has an important guiding significance for the clinical evaluation of atherosclerosis in patients with ICVD.