動脈僵硬度和阻塞程度的臨床應用課件

動脈僵硬度和阻塞程度的臨床應用劉金波北京大學首鋼醫(yī)院血管醫(yī)學中心南宮授課金波PWV南宮授課金波PWV南宮授課金波PWV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（Pulsecontouranalysis）直接方法：多普勒超聲脈搏波速度（Pulsewavevelocity）南宮授課金波PWV脈壓心臟收縮沿血管壁產(chǎn)生前向波，前向波受阻產(chǎn)生綜合性反射波南宮授課金波PWV脈壓前向波和反射波共同構(gòu)成了脈搏波形南宮授課金波PWV

脈壓當動脈僵硬度增高時，反射波速度加快南宮授課金波PWV脈壓南宮授課金波PWV收縮壓增高，舒張壓降低，脈壓明顯增大脈壓南宮授課金波PWV脈搏波速度

(pulsewavevelocity，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)血液流動速度南宮授課金波PWV脈搏波速度脈搏波速度≠血管內(nèi)血液流動速度南宮授課金波PWV南宮授課金波PWV通常，以頸總動脈搏動點作為脈搏波傳導的起點南宮授課金波PWV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itricoxidesynthase

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南宮授課金波PWV臨床疾?。焊哐獕禾悄虿」谛牟⌒墓δ懿蝗I功能不全影響脈搏波速度的因素南宮授課金波PWVTheeffectsofagingoncf-PWVinmalesandfemalesTheAnglo-CardiffCollaborativeTrial(ACCT)Subjects4,001healthynormotensivesaged19-90years.JAmCollCardiol2005;46:1753-600102030405060708090Age(years)PulseWaveVelocity(m/s)■■■■■■■■●●●●●●●●1612840FemalesMales南宮授課金波PWV高血壓AGE(Years)r=0.48***;y=0.123x+6.27203040506070809020161284AGE(Years)NT HTy=0.0628x+5.728 y=0.123x+6.27201612842030405060708090**p<0.001*Asmaretal,BloodPressure,1995HTNTn=224CAROTID-FEMORALP.W.V.(m/s)CAROTID-FEMORALP.W.V.(m/s)南宮授課金波PWV02468101214正常對照糖耐量低減糖尿病頸－股PWV(m/s)***16糖尿病AmJHypertens，1995；8：426-428南宮授課金波PWV糖尿病(AdaptedfromWoolametal.,1962)南宮授課金波PWV糖尿病相關(guān)蛋白尿(AdaptedfromTanokuchietal.,1962)南宮授課金波PWV冠心病南宮授課金波PWV冠心病以及家族史NORRISKCADMaleFemaleYamashinaAetal.HypertensRes2002

NORRISKCAD南宮授課金波PWV心功能不全adaptedfromArnoldetal.南宮授課金波PWV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-足背動脈南宮授課金波PWVHypertension2005;45;1078-1082.PatientswiththemetabolicsyndromehadagreateraorticPWV(9.7±2.0versus9.0±2.0m/s;P<0.03).Thisdifferenceheldaftercontrollingfortheconfoundingeffectofageandmeanarterialpressure.動脈僵硬度和代謝綜合征南宮授課金波PWV147mmHg動脈僵硬度和代謝綜合征Hypertension2005;45;1078-1082.南宮授課金波PWVHypertensRes2005;28:125–131動脈僵硬度和代謝綜合征南宮授課金波PWVQuestion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2、不同個體對動脈粥樣硬化危險因素的易感性3、對預后的預測

南宮授課金波PWVArterialstiffnessmaypredictcoronaryheartdiseasebeyondclassicriskfactors1045hypertensiveswithoutknownclinicalcardiovasculardiseasemeanfollow-upwas5.7yearsAdaptfromHypertension.2002;39:10-15.南宮授課金波PWVImpactofAorticStiffnessonSurvivalinEnd-StageRenalDiseaseAdaptfromCirculation.1999;99:2434-2439.南宮授課金波PWVConclusionsTheroleofarterialstiffeningwasindependentofotherfactorsknowntoaffecttheoutcomeofuremicpatients,namelyage,overalldurationofESRD,preexistingcardiovasculardisease,degreeofLVhypertrophy,BP,andserumalbuminandhemoglobinlevels.ImpactofAorticStiffnessonSurvivalinEnd-StageRenalDiseaseAdaptfromCirculation.1999;99:2434-2439.南宮授課金波PWVImpactofAorticStiffnessAttenuationonSurvivalinESRD南宮授課金波PWVTheriskratiofortheabsenceofPWVdecreasewas2.59forall-causemortalityand2.35forcardiovascularmortality.ImpactofAorticStiffnessAttenuationonSurvivalinESRD南宮授課金波PWVConclusions

Arterialstiffnessisnotonlyariskfactorcontributingtothedevelopmentofcardiovasculardiseasebutalsoamarkerofestablished,moreadvanced,lessreversiblearterialchanges.InESRFpatients,theinsensitivityofPWVtodecreasedBPisanindependentpredictorofmortalityImpactofAorticStiffnessAttenuationonSurvivalinESRD南宮授課金波PWVPWVisstrongsurrogatemarkerofcardiovasculareventsortotaldeath.

ASystematicReviewandMeta-AnalysisVlachopoulosCetal.JACC2010;55:1318-1327南宮授課金波PWVQuestion如何對動脈僵硬度增高進行干預？南宮授課金波PWVpwv&treatment長期藥物治療(≥28d)急性和短期藥物治療（<28d）南宮授課金波PWVPWV&ACEI確診的PAD患者40名：ABI<0.9，并經(jīng)血管超聲證實Ramipril(10mg,oncedaily）VS.安慰劑療程：24w南宮授課金波PWVRamiprilReducesLarge-ArteryStiffnessinPAD南宮授課金波PWVRamiprilReducesLarge-ArteryStiffnessinPAD南宮授課金波PWVcellcultureRamiprilReducesLarge-ArteryStiffnessinPAD南宮授課金波PWVRamiprilReducesLarge-ArteryStiffnessinPADcellculture南宮授課金波PWVFluvastatinandarterialstiffness22diateticpatientswithESRDonhaemodialysisReceivedfluvastatin(20mg/day)6monthsIndex:LDL-C,CRP,PWV南宮授課金波PWVFluvastatinandarterialstiffness南宮授課金波PWVFluvastatinandarterialstiffnessThebeneficialeffectoffluvastatinmayresultfromastatin-inducedupregulationofendothelialnitricoxidesynthaseexpressionand/oractivity.南宮授課金波PWVImprovedVascularComplianceby

AGE-CrosslinkBreakerAdvancedGlycationEnd-ProductCrosslinkBreaker：ALT-711共入選93人，隨訪56天隨機接受口服ALT-711(210mg,onceperday)或安慰劑入選標準：>50歲有動脈僵硬度增高的證據(jù)：PP>60mmHg,SBP>140mmHg,largearterycompliance<1.25mL/mmHg維持原有降壓藥物不變至少4周（ACEI/ARB，β-blocker，CCB，利尿劑）排除標準：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、嚴重腎臟疾病、活動性慢性肺部疾病、房顫、心功能不全等南宮授課金波PWVImprovedVascularComplianceby

AGE-CrosslinkBreaker南宮授課金波PWVImprovedVascularComplianceby

AGE-CrosslinkBreakerday＝28day＝56day＝28day＝56南宮授課金波PWV