曹志伟; 韩旭; 李静; 张静; 纪美玲; 刘立伟; 赵海燕; 吴云涛

doi:10.3760/cma.j.cn112148-20230117-00033

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• 临床研究 •

性别、年龄相关的臂踝脉搏波传导速度和脉压对全因死亡的单独及联合作用

中华心血管病杂志, 2023,51(3) : 296-302. DOI: 10.3760/cma.j.cn112148-20230117-00033

摘要

目的

探讨与性别、年龄相关的臂踝脉搏波传导速度（baPWV）与脉压对全因死亡的单独及联合作用。

方法

本研究为前瞻性队列研究，选取开滦研究中参加2010至2016年度健康体检、完成baPWV测量且后续进行了随访的人群作为研究对象。按照不同性别分层后，以每5岁为一组计算不同年龄组的baPWV和脉压的75%分位数，将<75%分位数定义为正常，将≥75%分位数定义为增高，根据baPWV和脉压水平，将研究对象分为4组：baPWV和脉压均正常组、baPWV增高和脉压正常组、baPWV正常和脉压增高组、baPWV和脉压均增高组。主要结局为全因死亡。采用Cox风险比例模型探讨baPWV和脉压对全因死亡的单独及联合作用。

结果

共纳入39 339人，年龄（49.3±12.8）岁，其中男性28 731人（73.03%）。baPWV和脉压均正常组、baPWV增高和脉压正常组、baPWV正常和脉压增高组、baPWV和脉压均增高组分别有23 268、6 025、6 210和3 836人。随访（4.98±2.53）年，共发生全因死亡998例。多因素Cox回归分析结果显示，与baPWV和脉压均正常组相比，baPWV增高和脉压正常组（HR=1.27，95%CI 1.07~1.50）、baPWV和脉压均增高组（HR=1.33，95%CI 1.08~1.65）发生全因死亡的风险增加；而单独脉压增高对全因死亡无影响（HR=1.06，95%CI 0.87~1.29）。

结论

与性别、年龄相关的baPWV与脉压均升高时全因死亡的发生风险明显增加，与脉压相比，baPWV可能是发生全因死亡更重要的预测因子。

引用本文: 曹志伟, 韩旭, 李静, 等. 性别、年龄相关的臂踝脉搏波传导速度和脉压对全因死亡的单独及联合作用 [J] . 中华心血管病杂志, 2023, 51(3) : 296-302. DOI: 10.3760/cma.j.cn112148-20230117-00033.

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

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随着年龄增加，动脉血管弹性蛋白断裂以及血管壁的钙化导致动脉僵硬程度增加^{［1, 2］}。既往研究表明动脉硬化与不同人群的死亡风险增加有关^{［3, 4］}，临床工作中通常将脉搏波传导速度（pulse wave velocity，PWV）作为衡量动脉僵硬程度的指标。脉压与动脉硬化密切相关，动脉僵硬程度增加会缩短动脉波反射的返回时间，导致收缩压升高、舒张压降低，从而引起脉压增加^{［5, 6］}。因此，脉压也被用作衡量动脉僵硬程度的替代指标。

贡献者信息

曹志伟

滦州市人民医院心内科，滦州　063700

韩旭

华北理工大学研究生学院，唐山　063000

开滦总医院心内科，唐山　063000

李静

滦州市人民医院心内科，滦州　063700

张静

滦州市人民医院心内科，滦州　063700

纪美玲

滦州市人民医院心内科，滦州　063700

刘立伟

滦州市人民医院心内科，滦州　063700

赵海燕

开滦总医院心内科，唐山　063000

吴云涛

开滦总医院心内科，唐山　063000

通信作者

吴云涛

开滦总医院心内科，唐山　063000

Email：wyt0086@163.com

关键词

动脉硬化; 臂踝脉搏波传导速度; 脉压; 全因死亡; 联合效应;

基金项目

河北省医学科学研究课题计划（20211609）

作者声明

作者贡献声明

韩旭、李静、张静、纪美玲、刘立伟、赵海燕：统计学分析、数据采集分析及文章撰写；曹志伟、吴云涛：研究设计及实施、获取研究经费及行政、技术或材料支持与指导

临床试验注册：

中国临床试验注册中心，ChiCTR-TNC-11001489

利益冲突

利益冲突：

所有作者声明无利益冲突

历史

出版日期：2023-03-24

收稿日期：2023-01-17

本文编辑

白洋

Clinical Investigation

Impact of individual and combined assessment of age- and sex-specific brachial-ankle pulse wave velocity and pulse pressure on all-cause mortality

Cao Zhiwei, Han Xu, Li Jing, Zhang Jing, Ji Meiling, Liu Liwei, Zhao Haiyan, Wu Yuntao

Published 2023-03-24

Cite as Chin J Cardiol, 2023, 51(3): 296-302. DOI: 10.3760/cma.j.cn112148-20230117-00033

Abstract

Objective

To evaluate the impact of individual and combined assessment of age- and sex-specific brachial-ankle pulse wave velocity (baPWV) and pulse pressure (PP) on all-cause mortality.

Methods

This study is a prospective cohort study. Individuals participated in the Kailuan Study and completed baPWV measurements between 2010 and 2016 were included in this study. After stratifying by sex, 75th percentile baPWV and PP values for different age group were calculated at five years interval. BaPWV and PP values below the 75th percentile were defined as normal, and those above or equal to the 75th percentile were defined as increased. The participants were allocated to four groups according to their PP and baPWV status: normal baPWV/PP group, high baPWV/normal PP group, normal baPWV/high PP group and high baPWV/PP group. The primary outcome was all-cause mortality during the follow-up period. Cox proportional hazards models were used to explore the impact of individual and combined assessment of baPWV and PP on all-cause mortality events.

Results

A total of 39 339 participants were enrolled in this study, aged (49.3±12.8) years, of which 28 731 (73.03%) were males. There were 23 268, 6 025, 6 210 and 3 836 cases in the normal baPWV/PP group, high baPWV/normal PP group, normal baPWV/high PP group and high baPWV/PP group, respectively. The average follow-up duration was (4.98±2.53) years. During the follow-up period, all-cause mortality occurred in 998 individuals. Multivariate Cox regression analysis showed increased risk of all-cause mortality in the high baPWV/normal PP group (HR=1.27, 95%CI 1.07-1.50), and in the high baPWV/PP group (HR=1.33, 95%CI 1.08-1.65) compared to the normal baPWV/PP group. Increased pulse pressure alone had no impcat on all-cause death (HR=1.06, 95%CI 0.87-1.29).

Conclusions

The risk of all-cause mortality significantly increases with increased age-and sex-specific baPWV and PP values. BaPWV may be a better predictor of all-cause mortality than PP in this cohort.

Key words:

Arterial stiffness; Brachial-ankle pulse wave velocity; Pulse pressure; All-cause mortality; Combined effects

Contributor Information

Cao Zhiwei