臂踝动脉脉搏波传导速度联合脉压指数对老年高血压患者冠心病的诊断及预测价值  

Diagnostic and predictive value of brachial-ankle pulse wave velocity and pulse pressure index for coronary heart disease in elderly patients with hypertension

作　　者：刘玥[1] 安亚娟 李娇 袁鹏 齐新[1] 魏丽萍[1] 杨华[1] LIU Yue;AN Yajuan;LI Jiao;YUAN Peng;QI Xin;WEI Liping;YANG Hua(Department of Cardiology,Tianjin Union Medical Center,Tianjin 300121,China;Tianjin University of Traditional Chinese Medicine)

机构地区：[1]天津市人民医院心内科,天津300121 [2]天津中医药大学

出　　处：《中华高血压杂志》2024年第1期51-56,共6页Chinese Journal of Hypertension

基　　金：天津市人民医院院内课题(2019YJ016);天津市中医药管理局课题(2021155,2021028)。

摘　　要：目的探讨臂踝动脉脉搏波传导速度(baPWV)和脉压指数对老年高血压合并冠心病的诊断及预测价值。方法连续收集2013年2月至2022年7月因胸痛或胸闷、憋气在天津市人民医院心内科住院并行冠状动脉造影的老年高血压患者307例为研究对象,其中未合并冠心病47例,合并冠心病260例,同时按Gensini评分将合并冠心病患者分为低危组(低于20分)96例,中危组(20~40分)80例,高危组(高于40分)84例,采用动脉踝臂指数及脉搏波测量装置测定baPWV,并测量收缩压、舒张压,计算脉压指数,分析各组患者baPWV、脉压指数的变化规律,以及与冠状动脉病变严重程度的相关性,采用多因素logistic回归分析冠心病发病的危险因素,绘制受试者工作特征(ROC)曲线评估各指标对冠心病的诊断价值。结果老年高血压合并冠心病低危、中危、高危组患者的脉压指数(0.43±0.04,0.45±0.04,0.45±0.05比0.41±0.05;F=31.768;P<0.001);baPWV[1671.00(1586.50,1754.75),1717.00(1596.50,1842.50),1780.00(1661.00,1960.00)比1570.00(1477.00,1699.00)cm/s;χ^(2)=60.918;P<0.001]均高于不合并冠心病组;并且随着冠状动脉病变程度的增加,脉压指数、baPWV明显升高(P<0.05)。Spearman/Pearson相关性分析显示,Gensini评分与baPWV、脉压指数均呈正相关(均P<0.001)。多因素logistic回归分析结果显示,baPWV、脉压指数及收缩压是老年高血压患者发生冠心病的危险因素(均P<0.05)。ROC曲线分析显示,baPWV、脉压指数以及两者联合诊断冠心病的ROC曲线下面积(95%CI)分别为0.792(0.723~0.861)、0.708(0.625~0.792)、0.837(0.779~0.895),两者联合与单独baPWV、脉压指数的曲线下面积比较,均差异有统计学意义(Z=-2.178,P=0.029;Z=-3.330,P=0.001)。结论随着冠状动脉病变程度的加重,baPWV、脉压指数升高。baPWV、脉压指数对老年高血压患者合并冠心病均有一定的诊断及预测价值,两者联合诊断准确性更高。Objective To explore the diagnostic and predictive value of brachial-ankle pulse wave velocity(baPWV)and pulse pressure index(PPI)for coronary heart disease(CHD)in elderly patients with hypertension.Methods A total of 307 elderly patients who had chest pain or chest distress and accepted coronary angiography in the Department of Cardiology,Tianjin Union Medical Center from February 2013 to July 2022 were enrolled.Among them,260 cases were complicated with CHD and 47 cases were not.According to the Gensini score,the patients with CHD were divided into low-risk group(<20 points,n=96),moderate-risk group(20-40 points,n=80)and high-risk group(>40 points,n=84).BaPWV was measured using an ankle-brachial index and pulse wave measuring device.Systolic and diastolic blood pressures were measured and PPI was calculated.The changes of baPWV and PPI in each group and the correlation of baPWV and PPI with the severity of CHD were analyzed.Multivariate logistic regression analysis was used to analyse the risk factors of CHD.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of baPWV and PPI for CHD.Results PPI and baPWV of elderly hypertensive patients with CHD at low,moderate,and high risk were higher than those without CHD[PPI:0.43±0.04,0.45±0.04,0.45±0.05 vs 0.41±0.05,F=31.768,P<0.001;baPWV:1671.00(1586.50,1754.75),1717.00(1596.50,1842.50),1780.00(1661.00,1960.00)vs 1570.00(1477.00,1699.00)cm/s,χ^(2)=60.918,P<0.001].And with the increase of CHD,the PPI and baPWV significantly increased(P<0.05).Spearman/Pearson correlation analysis showed that the Gensini score was positively correlated with baPWV and PPI,respectively(both P<0.001).Multivariate logistic regression analysis showed that baPWV,PPI and systolic blood pressure were the influencing factors of CHD in hypertensive patients.The ROC curve analysis showed that the areas under the ROC curve(95%CI)of baPWV,PPI,and their combination for diagnosing CHD were 0.792(0.723-0.861),0.708(0.625-0.792)and 0.837(0.779-0.895)respectively.There

关 键 词：脉压指数 臂踝动脉脉搏波传导速度 老年 高血压 冠心病 诊断 

分 类 号：R544.1[医药卫生—心血管疾病] R541.4[医药卫生—内科学]