多普勒法的脉搏波传导速度评价主动脉顺应性
摘要
研究背景
顺应性和扩张性是大动脉的物理特性，顺应性反映了动脉的缓冲功能。年龄增加、高血压、动脉粥样硬化、糖尿病和心力衰竭均能引起动脉顺应性下降。主动脉顺应性下降能增加心脏负荷，增加收缩压和脉压差，后者是独立的心血管危险因素。近年来研究证实作用于血管壁、血管内皮细胞或平滑肌细胞功能的药物均能改善动脉顺应性，因此评价主动脉顺应性具有广泛的临床意义。
尽管主动脉缓冲和传播搏动性的心脏射血在整个动脉树中贡献了大部分的顺应性，但无创评价动脉顺应性大多局限于浅表大动脉如颈动脉、肱动脉、股动脉。最近亦有应用经食道超声和有创的经血管内超声来研究人类主动脉顺应性，但应用多普勒超声测量脉搏波传导速度无创评价主动脉顺应性少见报道。
研究目的
探讨多普勒法的脉搏波传导速度无创评价主动脉顺应性的临床应用价值，并研究年龄、血压对主动脉顺应性的影响，具有一定的研究价值和应用前景。
浙江大学硕士学位论文
中文摘要
研究对象
丑三常组63例，男31例，女32例，年龄14一73岁，平均41
士16岁，无心血管病史，体检、心电图、心超检查均工E常。
高工位压病组，共20例，男6例，女14例，年龄38一82岁，
平均60士n岁，病不呈1一20年。高血.压确诊标准为收缩压)
140 mm Hg(1 mm Hg~0.133 kP幻，或(和)舒张压)90 mm Hg，
或正在服用降压药物者。所有受试者均为窦性心律。
研究方法
用多普勒法测量胸腹主动脉的脉搏波传导速度(P丫VV)，二二
维超声指导下的卜江型超声技术测量右颈总动脉收缩期及舒张
期内径，结合血压计算目前常用的反映动脉顺应性的指标:动
脉扩张性系数(DC)、动脉横断面顺应性(CC)、PETERSON‘S
弹性指数(Ep)、动脉僵硬度(p)，各指标按下列公式计算:
Dc~2△D代Ds><△P)，CC一△D><兀>< Ds/2△P，Ep一(△P/△D)>< Dd，p
一1n(sBp/DBP)/(△D/Dd)。随机选择30例间隔lh后由另一位观
察者重复测量各参数以验钻五测量重复性。采用SPSS 10.0 for
windows版本立注行数据统计分析。
结果
l全部受试者的Pwv与Dc、cc显著负相关，与Ep、p显著
j五才目三关(DC:r~一0 .655，尸<0.01; Cc:r-一0.562，尸<0.01;
EP:r=0 .707，尸<0.01;p:r=0.661，尸<0.01)。
2卫巨常组男女之间比较除CC外其它动脉顺应性参数均无显著
J性是盖歹手[P丫VV:6 .64士1 .84七匕6，37土1 .49 In/s，尸~0.528;Dc:
39.54士17.65卜匕35.43士12.62(10一3刀kpa)，尸=0.715;cc:
13.66士7.4卜匕10.49士3.66<10一7m2瓜Pa)，开0.035;它p:
5 5 .06士25.46卜匕53.39土21.9 kPa，尸=0.781;p:4.68士2.16卜匕
浙江大学硕士学位论文
中文摘要
4 .39士1 .63，尸~0.563]。
3高到1压组与年龄性别匹酉己的正常组比较各动脉顺应性参数
均有显著性差异[Pwv:5.92土1 .59比7.94士1 .14 rn/s，
p<0 .05;De:16.53土5.23卜匕25.34土9.53(10一3/kp幻，p<0.01;
ee:6 .15士1 .7卜匕5.42土2.99(10一7m2瓜Pa)，p<0.01;EP:
121.78土45.39 kpa七匕72.12士24.12 kpa，P<0.01;p:7.52士2.05
卜匕5 .83土2.1，P<0.05]。
4全部受试者中年龄和血压与Pwv、Ep、p显著正相关，与
Dc、cc显著负相关(P<0.001)。多元逐步回归分析结果显示
年龄和收缩压是与PYV、Z关系最密切的参数，回归方程为:
PVV、/一1 .429十O.O68xA(子E+0.157xSBP(AGE为全乒齿令，SBP为
收缩吏玉，尸<0.01)。
5各大动脉顺应性参数2次测值均无五遥著差异，具有显著相关
性，相关系数在0.84一0.91之间，尸值均<0-01，重复性好。
结论
1多普勒法的PV盯V与目前公认的超声评价颈动脉顺应性参数
均有显著相关性，上1测值具有较好的重复性，是一种石丁靠
的乍平价主动脉顺应性的指标。
2男女之间主动脉顺应性无显著差异。
3高血.压患者主动脉顺应性下降。
4年龄和血.压是影响P丫VV的二二个主要因素。随着年龄增加，
血‘压升高，主动脉顺应性下降，P丫V、Z加交权。
Background
Compliance and distensibility are physical properties of large arteries. Arterial compliance reflects the buffering capacity of an artery. Compliance of large conduit arteries has been found to be decreased as a result of aging, arterial hypertension, atherosclerosis, diabetes, and heart failure. A decrease in aortic compliance increases cardiac and vascular load and leads to increase in systolic pressure and pulse pressure, an independent risk factor for development of cardiovascular disease. With recent reports suggesting that arterial wall compliance is improved by drugs acting on vascular structure or endothelial cell or smooth muscle function, estimation of central aortic compliance in clinical settings may become more relevant.
Although the central aorta , acting as a compliant tube that buffers and conducts pulsatile ventricular output, contributes most to total compliance of the arterial tree, most studies employing noninvasive imaging modalities have focused on evaluating superficial arteries such as the carotid, brachial, and femoral arteries. Recently, aortic compliance in humans has been studied using two-dimensional and transesophageal echocardiography and invasive intravascular ultrasound, but noninvasive evaluation of aortic compliance with Doppler-derived pulse wave velocity(PWV) is rarely reported.
Objective
To determine clinical value of Doppler-derived PWV in evaluating aortic compliance and assess the effect of age and blood pressure on aortic compliance .
Subjects
The study group consisted of 63 normal subjects without a history of cardiovascular disease and with a normal physical examination, electrocardiogram and echocardiogram (31 male and 32 female; ranging in age from 38 to 82 years; mean 41 ±16 years ) and 20 hypertensive patients (6 male and 14 female; ranging in age from 14 to 73 years; mean 60 ±11 years ). Hypertensive patients had systolic blood pressure ≥140 mm Hg or(and) diastolic blood pressure ≥90 mm Hg, or taking antihypertensive agents. All subjects had sinus rhythm.
Methods
PWV along the descending thoracoabdominal aorta was measured non-invasively on the basis of Doppler ultrasound measurements in 63 normal subjects and 20 hypertensive patients, while using two-dimensional guided M-mode ultrasound measurements. We measured changes in arterial diameter of the right common carotid artery and calculated cross-sectional compliance (CC), distensibility coefficient (DC), the pressure-strain elastic modulus (Ep) and stiffness parameter (β ) from inner diameter, its pulsatile change, and blood pressure. The following formulas were used : DC=2ΔD /(Ds×ΔP), CC=ΔD× πΔDs/2ΔP, Ep=(ΔP/ΔD)×Dd, β=ln(SBP/DBP)/(ΔD/Dd), where SBP is systolic pressure; DBP is diastolic pressure; AP is the pulse pressure (=SBP-DBP);
Ds is the inner diameter at systole; Dd is the inner diameter at diastole; ΔD is the change in diameter (=Ds-Dd). Of 30 subjects had their above indices remeasured approximately one an houre after their first measurements to document the reproducibility of the technique. All data were analyzed by SPSS 10.0 for windows software.
Results
1 PWV was negatively correlated to DC, CC and positively to Ep , β in all subjects.
(DC: r = -0.655, P<0.01; CC: r = -0.562 , P<0.01; EP: r = 0.707 , P<0.01; β : r = 0.661 , P<0.01) .
2 The indices of arterial compliance, except to CC, had no significant difference between men and women in normal subjects [PWV: 6.64±1.84 vs6.37±1.49m/s, P=0.528; DC:
39.84±17.65 vs 38.43±12.62 (10-3/kPa), P=0.715; CC: 13.66±7.4 vs 10.49±3.66 C10-7m2/kPa), P=0.035; Ep: 55.06±25.46 vs 53.39±21.9 kPa , P=0.781; 0: 4.68±2.16vs4.39±1.63, P=0.563 ].
3 The indices of arterial compliance had significant difference between hypertensive patients and age-and gender-matched normal subjects [ PWV : 8.92±1.59 vs7.94±1.14 m/s, p<0.05; DC: 16.83±5.23 vs28.34±9.83(10-3/kPa), p<0.01; CC: 6.15±1.7 vs 8.42±2.99 C 10-7m2/kPa) , p<0.01
顺应性和扩张性是大动脉的物理特性，顺应性反映了动脉的缓冲功能。年龄增加、高血压、动脉粥样硬化、糖尿病和心力衰竭均能引起动脉顺应性下降。主动脉顺应性下降能增加心脏负荷，增加收缩压和脉压差，后者是独立的心血管危险因素。近年来研究证实作用于血管壁、血管内皮细胞或平滑肌细胞功能的药物均能改善动脉顺应性，因此评价主动脉顺应性具有广泛的临床意义。
尽管主动脉缓冲和传播搏动性的心脏射血在整个动脉树中贡献了大部分的顺应性，但无创评价动脉顺应性大多局限于浅表大动脉如颈动脉、肱动脉、股动脉。最近亦有应用经食道超声和有创的经血管内超声来研究人类主动脉顺应性，但应用多普勒超声测量脉搏波传导速度无创评价主动脉顺应性少见报道。
研究目的
探讨多普勒法的脉搏波传导速度无创评价主动脉顺应性的临床应用价值，并研究年龄、血压对主动脉顺应性的影响，具有一定的研究价值和应用前景。
浙江大学硕士学位论文
中文摘要
研究对象
丑三常组63例，男31例，女32例，年龄14一73岁，平均41
士16岁，无心血管病史，体检、心电图、心超检查均工E常。
高工位压病组，共20例，男6例，女14例，年龄38一82岁，
平均60士n岁，病不呈1一20年。高血.压确诊标准为收缩压)
140 mm Hg(1 mm Hg~0.133 kP幻，或(和)舒张压)90 mm Hg，
或正在服用降压药物者。所有受试者均为窦性心律。
研究方法
用多普勒法测量胸腹主动脉的脉搏波传导速度(P丫VV)，二二
维超声指导下的卜江型超声技术测量右颈总动脉收缩期及舒张
期内径，结合血压计算目前常用的反映动脉顺应性的指标:动
脉扩张性系数(DC)、动脉横断面顺应性(CC)、PETERSON‘S
弹性指数(Ep)、动脉僵硬度(p)，各指标按下列公式计算:
Dc~2△D代Ds><△P)，CC一△D><兀>< Ds/2△P，Ep一(△P/△D)>< Dd，p
一1n(sBp/DBP)/(△D/Dd)。随机选择30例间隔lh后由另一位观
察者重复测量各参数以验钻五测量重复性。采用SPSS 10.0 for
windows版本立注行数据统计分析。
结果
l全部受试者的Pwv与Dc、cc显著负相关，与Ep、p显著
j五才目三关(DC:r~一0 .655，尸<0.01; Cc:r-一0.562，尸<0.01;
EP:r=0 .707，尸<0.01;p:r=0.661，尸<0.01)。
2卫巨常组男女之间比较除CC外其它动脉顺应性参数均无显著
J性是盖歹手[P丫VV:6 .64士1 .84七匕6，37土1 .49 In/s，尸~0.528;Dc:
39.54士17.65卜匕35.43士12.62(10一3刀kpa)，尸=0.715;cc:
13.66士7.4卜匕10.49士3.66<10一7m2瓜Pa)，开0.035;它p:
5 5 .06士25.46卜匕53.39土21.9 kPa，尸=0.781;p:4.68士2.16卜匕
浙江大学硕士学位论文
中文摘要
4 .39士1 .63，尸~0.563]。
3高到1压组与年龄性别匹酉己的正常组比较各动脉顺应性参数
均有显著性差异[Pwv:5.92土1 .59比7.94士1 .14 rn/s，
p<0 .05;De:16.53土5.23卜匕25.34土9.53(10一3/kp幻，p<0.01;
ee:6 .15士1 .7卜匕5.42土2.99(10一7m2瓜Pa)，p<0.01;EP:
121.78土45.39 kpa七匕72.12士24.12 kpa，P<0.01;p:7.52士2.05
卜匕5 .83土2.1，P<0.05]。
4全部受试者中年龄和血压与Pwv、Ep、p显著正相关，与
Dc、cc显著负相关(P<0.001)。多元逐步回归分析结果显示
年龄和收缩压是与PYV、Z关系最密切的参数，回归方程为:
PVV、/一1 .429十O.O68xA(子E+0.157xSBP(AGE为全乒齿令，SBP为
收缩吏玉，尸<0.01)。
5各大动脉顺应性参数2次测值均无五遥著差异，具有显著相关
性，相关系数在0.84一0.91之间，尸值均<0-01，重复性好。
结论
1多普勒法的PV盯V与目前公认的超声评价颈动脉顺应性参数
均有显著相关性，上1测值具有较好的重复性，是一种石丁靠
的乍平价主动脉顺应性的指标。
2男女之间主动脉顺应性无显著差异。
3高血.压患者主动脉顺应性下降。
4年龄和血.压是影响P丫VV的二二个主要因素。随着年龄增加，
血‘压升高，主动脉顺应性下降，P丫V、Z加交权。
Background
Compliance and distensibility are physical properties of large arteries. Arterial compliance reflects the buffering capacity of an artery. Compliance of large conduit arteries has been found to be decreased as a result of aging, arterial hypertension, atherosclerosis, diabetes, and heart failure. A decrease in aortic compliance increases cardiac and vascular load and leads to increase in systolic pressure and pulse pressure, an independent risk factor for development of cardiovascular disease. With recent reports suggesting that arterial wall compliance is improved by drugs acting on vascular structure or endothelial cell or smooth muscle function, estimation of central aortic compliance in clinical settings may become more relevant.
Although the central aorta , acting as a compliant tube that buffers and conducts pulsatile ventricular output, contributes most to total compliance of the arterial tree, most studies employing noninvasive imaging modalities have focused on evaluating superficial arteries such as the carotid, brachial, and femoral arteries. Recently, aortic compliance in humans has been studied using two-dimensional and transesophageal echocardiography and invasive intravascular ultrasound, but noninvasive evaluation of aortic compliance with Doppler-derived pulse wave velocity(PWV) is rarely reported.
Objective
To determine clinical value of Doppler-derived PWV in evaluating aortic compliance and assess the effect of age and blood pressure on aortic compliance .
Subjects
The study group consisted of 63 normal subjects without a history of cardiovascular disease and with a normal physical examination, electrocardiogram and echocardiogram (31 male and 32 female; ranging in age from 38 to 82 years; mean 41 ±16 years ) and 20 hypertensive patients (6 male and 14 female; ranging in age from 14 to 73 years; mean 60 ±11 years ). Hypertensive patients had systolic blood pressure ≥140 mm Hg or(and) diastolic blood pressure ≥90 mm Hg, or taking antihypertensive agents. All subjects had sinus rhythm.
Methods
PWV along the descending thoracoabdominal aorta was measured non-invasively on the basis of Doppler ultrasound measurements in 63 normal subjects and 20 hypertensive patients, while using two-dimensional guided M-mode ultrasound measurements. We measured changes in arterial diameter of the right common carotid artery and calculated cross-sectional compliance (CC), distensibility coefficient (DC), the pressure-strain elastic modulus (Ep) and stiffness parameter (β ) from inner diameter, its pulsatile change, and blood pressure. The following formulas were used : DC=2ΔD /(Ds×ΔP), CC=ΔD× πΔDs/2ΔP, Ep=(ΔP/ΔD)×Dd, β=ln(SBP/DBP)/(ΔD/Dd), where SBP is systolic pressure; DBP is diastolic pressure; AP is the pulse pressure (=SBP-DBP);
Ds is the inner diameter at systole; Dd is the inner diameter at diastole; ΔD is the change in diameter (=Ds-Dd). Of 30 subjects had their above indices remeasured approximately one an houre after their first measurements to document the reproducibility of the technique. All data were analyzed by SPSS 10.0 for windows software.
Results
1 PWV was negatively correlated to DC, CC and positively to Ep , β in all subjects.
(DC: r = -0.655, P<0.01; CC: r = -0.562 , P<0.01; EP: r = 0.707 , P<0.01; β : r = 0.661 , P<0.01) .
2 The indices of arterial compliance, except to CC, had no significant difference between men and women in normal subjects [PWV: 6.64±1.84 vs6.37±1.49m/s, P=0.528; DC:
39.84±17.65 vs 38.43±12.62 (10-3/kPa), P=0.715; CC: 13.66±7.4 vs 10.49±3.66 C10-7m2/kPa), P=0.035; Ep: 55.06±25.46 vs 53.39±21.9 kPa , P=0.781; 0: 4.68±2.16vs4.39±1.63, P=0.563 ].
3 The indices of arterial compliance had significant difference between hypertensive patients and age-and gender-matched normal subjects [ PWV : 8.92±1.59 vs7.94±1.14 m/s, p<0.05; DC: 16.83±5.23 vs28.34±9.83(10-3/kPa), p<0.01; CC: 6.15±1.7 vs 8.42±2.99 C 10-7m2/kPa) , p<0.01
引文
1 Benetos A, Laurent S, Asmar RG, et al. Large artery stiffness in hypertension. J Hypertens Suppl. 1997, 15(2): s89-s97.
2 Benetos A. Pulse pressure and cardiovascular risk. J Hypertens. 1999, 17(Supple 5): s21-s24.
3 胡大一，王宏宇．主动脉僵硬度与急性冠脉事件．中国医刊．2002，37(5)：4-6．
4 Wada T, Fujishiro K, Fukumoto T, et al. Relationship between ultrasound assessment of arterial wall properties and blood pressure, mngiology. 1997, 48(10): 893-900.
5 Gamble G, Zorn J, Sanders G, et al. Estimation of arterial stiffness, compliance, and distensibility from M-mode ultrasound measurements of the common carotid artery. Stroke. 1994, 25(1): 11-16.
6 卢纹岱主编．SPSS for windows 统计分析．第1版．北京：电子工业出版社．153-302．
7 Glasser SP, Amett DK, McVeigh GE, et al. Vascular compliance and cardiovascular disease: a risk factor or a marker? Am J Hypertens. 1997, 10(10 Pt 1): 1175-1189.
8 RG Asmar, B Pannier, JP Santoni, et al. Reversion of cardiac hypertrophy and reduced arterial compliance after co nverting enzyme inhibition in essential hypertension. Circulation. 1988, 78: 941-950.
9 Lage SG, Kopel L, Medeiros CC, et al. Angiotensin Ⅱ contributes to arterial compliance in congestive heart failure. Am J Physiol Heart Circ Physiol. 2002, 283(4): H1424-H1429.
10 Asmar RG, Benetos A, Chaouche-Teyara K, et al. Comparison of effects of felodipine versus hydrochlorothiazide on arterial diameter and pulse-wave velocity in essential hypertension.Am J Cardiol. 1993, 72(11): 794-798.
11 王宏宇，张维忠，龚兰生，等．高血压患者心脏及大动脉结构和功能改变及降压治疗的效应．高血压杂志．2002，10(3)：210～213．
12 van der Heijden-Spek JJ, Staessen JA, Fagard RH, et al. Effect of age on brachial artery wall properties differs from the aorta and is gender dependent: a population study. Hypertension.2000, 35(2): 637-642.
13 Kuecherer HF, Just A, Kirchheim H. Evaluation of aortic compliance in humans. Am J Physiol Heart Circ Physiol. 2000, 278(5): H1411-H1413.
14 Asmar R, Benetos A, Topouchian J, et al. Assessment of arterial distensibility by automatic pulse wave velocity measurement: Validation and clinical application studies.Hypertension. 1995, 26(3): 485-490.
15 王宏宇，龚兰生，张维忠，等．不同年龄高血压患者大动脉扩张性的临床研究．中华老年心脑血管病杂志．2000，3(6)：384～386．
16 Toikka JO, Niemi P, Ahotupa M, et al. Large-artery elastic
properties in young men: relationships to serum lipoproteins and oxidized low-density lipoproteins, mrterioscler Thromb Vase Biol. 1999, 19(2): 436-441.
17 Pearson AC, Guo R, Orsinelli DA, et al. Transesophageal echocardiographic assessment of the effects of age, gender,and hypertension on thoracic aortic wall size, thickness, and stiffness. Am Heart J. 1994, 128(2): 344-351.
18 张薇，张学义．年龄对胸主动脉结构和功能影响的相关性研究．中国老年学杂志．2000，20(4)：202-203．
19 Hardt, E, Just A, Bekeredjian R, et al. Aortic pressure-diameter relationship assessed by intravascular ultrasound: experimental validation in dogs. Am J Physiol Heart Circ Physiol. 1999, 276: H1078-H1085.
20 Lehmann ED, Hopkins KD, Rawesh A, et al. Relation between number of cardiovascular risk factors/events and noninvasive Doppler ultrasound assessments of aortic compliance. Hypertension. 1998, 32(3): 565-569.
21 Faith Seizer, Kim Sutton-Tyrrell, Shirley Fitzgerald, et al. Vascular Stiffness in Women With Systemic Lupus Erythematosus. Hypertension. 2001, 37: 1075-1082.
22 Liang YL, Gatzka CD, Du XJ, et al. Effects of heart rate on arterial compliance in men. Clin Exp Pharmacol Physiol.1999, 26(4): 342-346.
23 Weinberger MH, Fineberg NS, Fineberg SE. Effects of age,race, gender, blood pressure, and estrogen on arterial compliance. Am J Hypertens. 2002, 15(4 Pt 1): 358-363.
24 Learoyd BM, Taylor MG. Alterations with age in the
viscoelastic properties of human arterial walls. Circ Res.1966, 18(3): 278-292.
2 Benetos A. Pulse pressure and cardiovascular risk. J Hypertens. 1999, 17(Supple 5): s21-s24.
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