動脈僵硬度和阻塞程度的臨床應(yīng)用

1、動脈僵硬度和阻塞程度的臨床應(yīng)用評價大動脈僵硬度的方法間接方法：血壓測量(SBP&PP)脈搏波形分析（Pulse contour analysis）直接方法：多普勒超聲脈搏波速度（Pulse wave velocity）脈壓心臟收縮沿血管壁產(chǎn)生前向波，前向波受阻產(chǎn)生綜合性反射波脈壓前向波和反射波共同構(gòu)成了脈搏波形脈壓當(dāng)動脈僵硬度增高時，反射波速度加快脈壓收縮壓增高，舒張壓降低，脈壓明顯增大脈壓脈搏波速度(pulse wave velocity，PWV)定義： 左室射血產(chǎn)生脈搏波以一定速度沿動脈壁向全身傳播。左室脈搏波速度血管內(nèi)血液流動速度脈搏波速度脈搏波速度血管內(nèi)血液流動速度通常，以頸總動脈搏動

2、點(diǎn)作為脈搏波傳導(dǎo)的起點(diǎn)生理因素：年齡：10歲以前大動脈僵硬度隨年齡增長迅速下降，但隨后的50年內(nèi)則逐漸升高性別：成年女性PWV略小于同齡男性，而在兒童和老年人群（即老年男性和絕經(jīng)后女性）性別差異不明顯?；颍簄itric oxide synthase 血壓：無論是由于動脈性質(zhì)改變，或是由于動脈內(nèi)壓力增大，均可致PWV增加心率：長期心率較快可造成退行性改變加速影響脈搏波速度的因素臨床疾病：高血壓糖尿病冠心病心功能不全腎功能不全影響脈搏波速度的因素The effects of aging on cf-PWV in males and females The Anglo-Cardiff Collab

3、orative Trial(ACCT) Subjects 4,001 healthy normotensives aged 19-90years.J Am Coll Cardiol 2005;46:1753-600102030405060708090Age (years)Pulse Wave Velocity(m/s)1612840FemalesMales高血壓AGE (Years)r = 0.48* ; y = 0.123x + 6.2720 30 40 50 60 70 80 90201612 8 4AGE (Years)NTHTy = 0.0628x + 5.728 y = 0.123x

4、 + 6.27201612 8 420 30 40 50 60 70 80 90* p 0.001*Asmar et al, Blood Pressure, 1995HTNTn = 224CAROTID-FEMORAL P.W.V. (m/s)CAROTID-FEMORAL P.W.V. (m/s)02468101214正常對照糖耐量低減糖尿病頸股 PWV (m/s)*16糖尿病Am J Hypertens，1995；8：426-428糖尿病(Adapted from Woolam et al., 1962)糖尿病相關(guān)蛋白尿(Adapted from Tanokuchi et al., 196

5、2)冠心病冠心病以及家族史NOR RISK CADMaleFemaleYamashina A et al. Hypertens Res 2002 NOR RISK CAD心功能不全adapted from Arnold et al.動脈僵硬度和慢性腎功能不全 Hypertension，1992;20:10-19cf-pwv：頸-股動脈cr-pwv：頸-橈動脈ff-pwv：股-足背動脈Hypertension2005;45;1078-1082.Patients with the metabolic syndrome had a greater aortic PWV(9.72.0 versus 9

6、.02.0m/s;P0.03).This difference held after controlling for the confounding effect of age and mean arterial pressure.動脈僵硬度和代謝綜合征147 mm Hg動脈僵硬度和代謝綜合征Hypertension2005;45;1078-1082.Hypertens Res 2005;28:125131動脈僵硬度和代謝綜合征Question動脈僵硬度升高意味著什么？1、動脈粥樣硬化危險因素綜合作用引起血管損害的早期指標(biāo)2、不同個體對動脈粥樣硬化危險因素的易感性3、對預(yù)后的預(yù)測Arteria

7、l stiffness may predict coronary heart disease beyond classic risk factors1045 hypertensives without known clinical cardiovascular diseasemean follow-up was 5.7 yearsAdapt from Hypertension. 2002;39:10-15.Impact of Aortic Stiffness on Survival in End-Stage Renal DiseaseAdapt from Circulation. 1999;9

8、9:2434-2439.Conclusions The role of arterial stiffening was independent of other factors known to affect the outcome of uremic patients, namely age, overall duration of ESRD, preexisting cardiovascular disease, degree of LV hypertrophy, BP, and serum albumin and hemoglobin levels.Impact of Aortic St

9、iffness on Survival in End-Stage Renal DiseaseAdapt from Circulation. 1999;99:2434-2439.Impact of Aortic Stiffness Attenuation on Survival in ESRDThe risk ratio for the absence of PWV decrease was 2.59 for all-cause mortality and 2.35 for cardiovascular mortality.Impact of Aortic Stiffness Attenuati

10、on on Survival in ESRDConclusions Arterial stiffness is not only a risk factor contributing to the development of cardiovascular disease but also a marker of established, more advanced, less reversible arterial changes. In ESRF patients, the insensitivity of PWV to decreased BP is an independent pre

11、dictor of mortalityImpact of Aortic Stiffness Attenuation on Survival in ESRDPWV is strong surrogate marker of cardiovascular events or total death. A Systematic Review and Meta-AnalysisVlachopoulos C et al. JACC 2010;55:1318-1327Question如何對動脈僵硬度增高進(jìn)行干預(yù)？pwv & treatment長期藥物治療(28d)急性和短期藥物治療（28d）PWV & A

12、CEI確診的PAD患者40名：ABI50歲有動脈僵硬度增高的證據(jù)：PP 60 mm Hg, SBP140 mm Hg, large artery compliance 1.25 mL/mm Hg維持原有降壓藥物不變至少4周（ACEI/ARB，-blocker，CCB，利尿劑）排除標(biāo)準(zhǔn)：已知的心腦血管疾病、心臟瓣膜病、惡性高血壓、1型或未控制穩(wěn)定的2型糖尿病、嚴(yán)重腎臟疾病、活動性慢性肺部疾病、房顫、心功能不全等Improved Vascular Compliance by AGE-Crosslink BreakerImproved Vascular Compliance by AGE-Crosslink Breakerday28 day 56day28 day 5650科研-Idea1、一定要大量地、仔細(xì)地閱讀