臂踝动脉脉搏波传导速度与新发脑卒中的关系  

Relationship between brachial-ankle pulse wave velocity and new-onset stroke

作　　者：王艳秀[1] 霍映冬 赵权辉 梁欣[1] 刘爱华[3] 邢爱君[1] 赵海燕[1] 吴寿岭[1] WANG Yan-xiu;HUO Ying-dong;ZHAO Quan-hui;LIANG Xin;LIU Ai-hua;XING Ai-jun;ZHAO Hai-yan;WU Shou-ling(Department of Cardiology,Kailuan General Hospital,Tangshan Hebei 063000,China;不详)

机构地区：[1]开滦总医院心内科,河北唐山063000 [2]唐山市医疗保险事业局 [3]唐山市第八医院内科

出　　处：《中华高血压杂志》2020年第12期1115-1119,共5页Chinese Journal of Hypertension

摘　　要：目的探讨臂踝动脉脉搏波传导速度(baPWV)与新发脑卒中的关系。方法本研究采用前瞻性队列研究的方法,观察对象为参加了2010-2013年健康体检且完成baPWV检测,基线无脑卒中病史的唐山开滦集团员工共14 832例,随访其新发脑卒中事件至2017年12月31日。对baPWV进行四分位分组(Q1:baPWV<12.59;Q2:baPWV 12.59~<14.49;Q3:baPWV 14.49~<17.12;Q4:baPWV≥17.12 m/s),采用Log-rank检验比较各组新发脑卒中累积发生率的差异,Cox比例风险模型和自然样条函数分析baPWV对新发脑卒中的影响。结果平均随访(6.00±1.18)年,总脑卒中事件、缺血性脑卒中和出血性脑卒中的累积发生率随着baPWV的加快而呈上升趋势(Q1、Q2、Q3、Q4组总脑卒中事件分别为0.22%、1.02%、3.08%、6.10%;缺血性脑卒中事件分别为0.22%、0.89%、2.84%、5.50%,出血性脑卒中事件分别为0.03%、0.16%、0.32%、0.70%,均P<0.01)。Cox比例风险模型分析发现,校正其他混杂因素后,与Q1组相比,Q2、Q3、Q4组发生总脑卒中事件的HR值(95%CI)分别为2.50(1.04~6.02)、4.88(2.10~11.33)、6.39(2.71~15.05);发生缺血性脑卒中的HR值(95%CI)分别为2.16(0.89~5.25)、4.39(1.88~10.24)、5.48(2.31~12.99);发生出血性脑卒中的HR值(95%CI)分别为2.77(0.32~24.27)、3.78(0.45~31.75)、7.71(0.90~66.22)。baPWV每增加1个标准差,发生总脑卒中事件、缺血性脑卒中和出血性脑卒中的HR值(95%CI)分别为1.32(1.18~1.48)、1.30(1.15~1.46)、1.51(1.11~2.05)。自然样条函数分析显示校正其他混杂因素后,baPWV与总脑卒中事件、缺血性脑卒中、出血性脑卒中的发生均呈现类似直线关系(P<0.01)。结论 baPWV的加快增加新发总脑卒中事件和缺血性脑卒中的风险。Objective To investigate the relationship between brachial-ankle pulse wave velocity(baPWV) and new-onset stroke. Methods This was a prospective cohort study. A total of 14 832 employees of Kailuan Group of Tangshan who took the physical examination, including baPWV test, from 2010 to 2013 with no stroke history at the baseline were recruited and followed up for stroke events to Dec 31 th, 2017. Subjects were divided into four groups according to baPWV(Q1: baPWV<12.59;Q2: baPWV 12.59-<14.49;Q3: baPWV 14.49-<17.12;Q4: baPWV≥17.12 m/s). Cumulative incidence of new-onset stroke in each group was compared by log-rank test, and the effect of baPWV on new-onset stroke was analyzed by Cox proportional hazard model and natural spline function. Results During a mean follow-up of(6.00±1.18) years, the cumulative incidence of total, ischemic and hemorrhagic stroke were all increased with the increasing of baPWV. The incidence of total stroke in each group was 0.22%,1.02%, 3.08%, 6.10%, which was 0.22%, 0.89%, 2.84%, 5.50% for ischemic stroke, and 0.03%, 0.16%, 0.32%, 0.70% for hemorrhagic stroke(all P<0.01). In Cox proportional hazards model analysis, after adjusting for other confounding factors, compared with Q1 group, the HR(95% CI) of total stroke in Q2, Q3 and Q4 group was 2.50(1.04-6.02), 4.88(2.10-11.33) and 6.39(2.71-15.05), which was 2.16(0.89-5.25), 4.39(1.88-10.24), 5.48(2.31-12.99) for ischemia stroke, and 2.77(0.32-24.27), 3.78(0.45-31.75), 7.71(0.90-66.22) for hemorrhagic stroke. By every one increase of standard deviation of baPWV, the HR(95% CI) of total, ischemic and hemorrhagic stroke increased 1.32(1.18-1.48), 1.30(1.15-1.46) and 1.51(1.11-2.05) respectively. Similar linear relationships were revealed between baPWV and total, ischemic and hemorrhagic stroke by natural spline function analysis after adjusting for other confounding factors(P<0.01). Conclusion Increased baPWV increases the risk of new-onset total and ischemic stroke.

关 键 词：臂踝动脉脉搏波传导速度 脑卒中 动脉硬化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]