PWV脉搏波速度

PWV脉搏波速度 脉搏波速度(PWV)在临床无创检测中的应用 心脑血管疾病已成为威胁人类健康的主要疾病，动脉硬化在其中起着重要的作用，而高血压、糖尿病又增加了动脉硬化的危险性。高血压并发症的患 病率和死亡率主要与动脉壁的损害有关，动脉壁的结构和功能的改变甚至在高血压的早期就已经发生。考虑到动脉硬化程度评估在心血管疾病防治方面的潜在作用， 世界卫生组织(WHO)建议通过动脉僵硬度的改善程度来评价降压药物的效果。作为评估动脉僵硬度的一个指标，脉搏波波速(PWV)的作用正日益引起重视。 目前，国外PWV测定在临床试验中有多方面的应用。 一、PWV简介 所谓PWV，指的是脉搏波在动脉系统的两个既定点间的传播速度，根据Moens-Korteweg方程，PWV与弹性系数的平方根成正比，由于动脉弹性 的减低，脉搏波在动脉系统的传播速度加快了。近年来，由于PWV与动脉僵硬度的这种正相关性，再加上它的测量方法简便易行而又没有创伤，所以，被广泛应用来作为评估动脉硬化程度的一个指标。颈动脉一股动脉PWV、肱动脉一踝动脉PWV常用于临床检测。PWV可以良好地反映大动脉的扩张性，PWV越快，动脉的扩张性越差、僵硬度越高、弹性越差。 Siebenhofer等的研究结果更显示，经过培训的不同研究人员之间所测得的PWV值几乎相同，显示了极好的可重复性。Asmar教授1995年采 用全自动测量的Complior(康普乐)检验了PWV测量的重复性，结果进一步说明PWV检测具有极好的重复性。目前，这种测量方法已should be conducted in the presence of the supervisor. (7) monitoring instruments and equipment should be checked and corrected after installation, Embedment, and submit calibration reports. Supervision inspection acceptance shall be measured immediately after reading initial values. (8) each measuring point for each observation section within 14 days after planting, to submit their research laid the table control. (9) in the course of construction, all monitoring equipment should be protected, the supervisor requested protection area shall provide protective cover and logo. 10.5.2 surface deformation monitoring (1) surface deformation monitoring point Pier in-situ reinforced concrete Pier, the pier above the ground 1.2m, in undisturbed soil or bedrock (native) deep 1.0~1.5M. (2) the pier top of forced centering plate. (3) when planted, forced centering plate should be horizontal, angle not greater than 4 '. 10.5.3 level monitoring point (1) in the standard location monitoring points around the reserve pit formwork, aspect to facilitate in the leveling of the pit shall prevail. (2) the standard markers together with the accessories insert the bottom has not been final set in advance concrete, exposed bottom concrete 经成为PWV检测 的“金”。 动脉硬化与PWV:动脉僵硬度与年龄呈正相关，这主要是由于血管壁中层退行性变，中层胶原含量增加，导致弹力层随着年龄的增长而断裂，伴有中层纤维化和 钙化。其它相关因素包括性别、吸烟、高血压、糖尿病、高胆固醇血症等。而高血压、动脉退行性变、心血管疾病又加剧了动脉硬化的进程，这种变化尤以中心弹力 血管，如主动脉为显著。动脉硬化又导致了大动脉缓冲功能障碍，引起脉压(PP)以及收缩压(SBP)不成比例地增加，由此，引发了左室后负荷的增加以及冠 状动脉缺血的加重，冠状动脉灌注压降低，收缩期压力跃升，增加收缩末期左室应力，导致左室肥厚。 鉴于PWV与动脉硬化及高血压的关系，PWV测量近年来被广泛使用。Blacher等对约530名高血压患者所做的研究提示，根据Framingham 方程式，PWV与AA的存在及程度具有显著相关性，而且，PWV>13mPs作为心血管疾病发生危险性的强预测因子具有很高的应用价值。在没有动脉 粥样硬化的患者中，随着PWV的升高，心肌梗死(MI)、冠心病(CHD)、CHD死亡率、中风、心血管疾病(CVD)以及CVD死亡率都随之上升。所有 心血管疾病的危险因子与PWV的升高呈线性相关。而且，在任一年龄，大动脉PWV都是心血管疾病死亡率最好的预测因子。60岁以上人群 中，PWV>13-15m/s发生心血管病死亡的相对危险度(OR值)为7.11。Asmar等对1470名原发性高血压患者的横断面研究也表 明，PWV的升高与CVD的存在具有显著相关性，这种相关性独立于抗高血压治疗而存在。 should be conducted in the presence of the supervisor. (7) monitoring instruments and equipment should be checked and corrected after installation, Embedment, and submit calibration reports. Supervision inspection acceptance shall be measured immediately after reading initial values. (8) each measuring point for each observation section within 14 days after planting, to submit their research laid the table control. (9) in the course of construction, all monitoring equipment should be protected, the supervisor requested protection area shall provide protective cover and logo. 10.5.2 surface deformation monitoring (1) surface deformation monitoring point Pier in-situ reinforced concrete Pier, the pier above the ground 1.2m, in undisturbed soil or bedrock (native) deep 1.0~1.5M. (2) the pier top of forced centering plate. (3) when planted, forced centering plate should be horizontal, angle not greater than 4 '. 10.5.3 level monitoring point (1) in the standard location monitoring points around the reserve pit formwork, aspect to facilitate in the leveling of the pit shall prevail. (2) the standard markers together with the accessories insert the bottom has not been final set in advance concrete, exposed bottom concrete Boutouyrie等对1045例临床无心血管病的高血压患者进行了研究，在基线测量患者的PWV，并根据性别、年龄、血压、胆固醇、糖尿病和吸烟情 况计算Framingham危险评分，评估冠心病发生危险，平均随访期为5.17年。结果显示，在随访期共发生了53次冠脉事件和97次心血管事件。经单 变量分析，PWV传播速度增加者，冠脉事件和心血管事件发病危险增加;PWV增加一个标准差(3.15m/s)，发生冠脉事件的相对危险为 11.42(P<0.01)，发生心血管事件的相对危险为11.41(P<0.001)。多变量分析显示，对Framingham危险评分因 素进行校正后，PWV增加一个标准差，发生冠脉事件的相对危险为11.34(P=0.039);对众所周知的危险因素进行校正后，发生冠脉事件的相对危险 为11.39(P=0.01)。研究者认为，PWV测定有助于确定冠心病高危病人，使这部分病人从更加积极的治疗中获益。 二、PWV对终末期肾病(ESRD)患者心血管疾病危险性的预测 ESRD患者是心血管疾病的高危人群。流行病学调查及临床研究表明，大血管损害是ESRD患者心血管疾病高发病率及死亡率的主要辅助因子，大血管疾病在尿毒症患者中进展尤为迅速。PWV在ESRD患者中的预测作用不容忽视。 三、PWV与糖尿病 动脉硬度的增加是糖尿病患者的另一个特征，这可能是由于循环中糖基化终末产物增加的缘故。而且，在2型糖尿病患者中，连续动脉血压监测发现，PP升高是一个普遍现象。 动脉硬度增加与糖尿病、高血糖、高胰岛素血症以及糖耐量异常should be conducted in the presence of the supervisor. (7) monitoring instruments and equipment should be checked and corrected after installation, Embedment, and submit calibration reports. Supervision inspection acceptance shall be measured immediately after reading initial values. (8) each measuring point for each observation section within 14 days after planting, to submit their research laid the table control. (9) in the course of construction, all monitoring equipment should be protected, the supervisor requested protection area shall provide protective cover and logo. 10.5.2 surface deformation monitoring (1) surface deformation monitoring point Pier in-situ reinforced concrete Pier, the pier above the ground 1.2m, in undisturbed soil or bedrock (native) deep 1.0~1.5M. (2) the pier top of forced centering plate. (3) when planted, forced centering plate should be horizontal, angle not greater than 4 '. 10.5.3 level monitoring point (1) in the standard location monitoring points around the reserve pit formwork, aspect to facilitate in the leveling of the pit shall prevail. (2) the standard markers together with the accessories insert the bottom has not been final set in advance concrete, exposed bottom concrete 有关。在年长一些的成年人中，研究显示，胰岛素抵抗、高胰岛素血症以及高血糖可能促进了动脉硬化的发生与发展，这种作用独立于年龄而存在。 高血糖可以激活胶原蛋白分解，导致蛋白多糖沉积于动脉壁，从而引起动脉壁的破坏、硬化。2型糖尿病增加某些类型大血管疾病的危险性。在西方人群 中，CHD是2型糖尿病患者最常见的死亡原因，糖尿病人群死于CHD的危险性约增加了3倍，非致死性心梗和充血性心衰的危险性增长幅度相类似。 肾脏病变是2型糖尿病的一个常见的微血管并发症。在长期研究中，确诊为糖尿病20年以上的患者肾脏病变的累积发生率约为27%-60%，出现蛋白尿后 10年ESRD的发生率约为10%-35%，糖尿病是大部分西方人ESRD的主要原因。伴有糖尿病的ESRD患者心血管疾病死亡率更高，这可能是由于糖尿 病加剧了患者动脉硬化的程度。PWV是一个极强的心血管病死亡以及总死亡的预测因子。关于PWV对ESRD患者心血管疾病发病风险的预测因子。PWV在心 血管疾病防治方面的应用前景与展望。 新的药物治疗的目标应该是通过减少动脉壁厚度，改变它的构成来调整动脉壁的结构。此外，由于PWV测定的简便、快捷、无创，加之近年全自动测量的 Complior在临床上的普遍应用，很适合应用于普通人群研究，预测心血管疾病的发生风险，以利于早期采取干预措施。Meaume等对124名70岁以 上的老年人进行的研究表明，PWV是CVD的独立的强预测因子，调整后发生CVD的相对危险为17.1。Meaumeshould be conducted in the presence of the supervisor. (7) monitoring instruments and equipment should be checked and corrected after installation, Embedment, and submit calibration reports. Supervision inspection acceptance shall be measured immediately after reading initial values. (8) each measuring point for each observation section within 14 days after planting, to submit their research laid the table control. (9) in the course of construction, all monitoring equipment should be protected, the supervisor requested protection area shall provide protective cover and logo. 10.5.2 surface deformation monitoring (1) surface deformation monitoring point Pier in-situ reinforced concrete Pier, the pier above the ground 1.2m, in undisturbed soil or bedrock (native) deep 1.0~1.5M. (2) the pier top of forced centering plate. (3) when planted, forced centering plate should be horizontal, angle not greater than 4 '. 10.5.3 level monitoring point (1) in the standard location monitoring points around the reserve pit formwork, aspect to facilitate in the leveling of the pit shall prevail. (2) the standard markers together with the accessories insert the bottom has not been final set in advance concrete, exposed bottom concrete 等对141名70岁-100岁老年人 进行了另一项前瞻性研究，在长达30个月的随访中，总共发生了56例死亡，其中27例死于心血管事件。Logistic回归分析表明，PWV是心血管事件 死亡的独立预测因子。 医生认为:近年来由于PWV与动脉僵硬度的正相关性，再加上它的测量方法简便易行而又不造成创伤，所以被广泛应用来作为评估动脉僵硬度的一个指标。PWV可以较好地反映大动脉的扩张性，PWV越快，动脉的扩张性越差，僵硬度越高，弹性越差。 should be conducted in the presence of the supervisor. (7) monitoring instruments and equipment should be checked and corrected after installation, Embedment, and submit calibration reports. Supervision inspection acceptance shall be measured immediately after reading initial values. (8) each measuring point for each observation section within 14 days after planting, to submit their research laid the table control. (9) in the course of construction, all monitoring equipment should be protected, the supervisor requested protection area shall provide protective cover and logo. 10.5.2 surface deformation monitoring (1) surface deformation monitoring point Pier in-situ reinforced concrete Pier, the pier above the ground 1.2m, in undisturbed soil or bedrock (native) deep 1.0~1.5M. (2) the pier top of forced centering plate. (3) when planted, forced centering plate should be horizontal, angle not greater than 4 '. 10.5.3 level monitoring point (1) in the standard location monitoring points around the reserve pit formwork, aspect to facilitate in the leveling of the pit shall prevail. (2) the standard markers together with the accessories insert the bottom has not been final set in advance concrete, exposed bottom concrete