Munakata Masanori, Sakuraba Junko, Tayama Jun, Furuta Takashi, Yusa Akira, Nunokawa Tohru, Yoshinaga Kaoru, Toyota Takayoshi
Preventive Medical Center, Tohoku Rosai Hospital, Sendai, Japan.
Hypertens Res. 2005 Jan;28(1):9-14. doi: 10.1291/hypres.28.9.
Brachial-ankle pulse wave velocity is a new measure of arterial stiffness. We examined whether higher brachial-ankle pulse wave velocity is associated with more advanced carotid atherosclerosis and left ventricular hypertrophy in patients with end-stage renal disease, and whether this effect would be mediated by the influence of wave reflection on central arterial pressure. In 68 patients with end stage renal disease, we examined blood pressures, brachial-ankle pulse wave velocity and the augmentation index of the left common carotid artery, a measure of the impact of wave reflection on the systolic peak in central arteries. The degree of carotid atherosclerosis was quantified by a plaque score and maximum intimal-medial thickness. Echocardiography was used to determine the left ventricular mass index. In simple regression analysis, brachial-ankle pulse wave velocity was correlated with both plaque score and maximum intimal-medial thickness (r = 0.420, p < 0.001 and r = 0.452, p < 0.0005, respectively) but not with left ventricular mass index. Multiple regression analysis was performed with the plaque score or maximum intimal-medial thickness as the dependent variable and brachial-ankle pulse wave velocity and known clinical risk factors as the independent variables. The brachial-ankle pulse wave velocity was an independent risk factor for both plaque score (beta = 0.006, p = 0.004) and maximum intimal-medial thickness (beta = 0.008, p = 0.04). Independent risk factors for left ventricular mass index were left ventricular diastolic dimension (beta = 3.509, p = 0.000007) and augmentation index (beta = 0.580, p = 0.04). The brachial-ankle pulse wave velocity was unrelated to augmentation index in patients with end stage renal disease. In conclusion, higher brachial-ankle pulse wave velocity was found to be a risk factor for carotid atherosclerosis in patients with end-stage renal disease; this effect was independent of the influence of wave reflection on central arterial pressure. The brachial-ankle pulse wave velocity was unrelated to left ventricular structure.
臂踝脉搏波速度是一种新的动脉僵硬度测量指标。我们研究了较高的臂踝脉搏波速度是否与终末期肾病患者更严重的颈动脉粥样硬化和左心室肥厚相关，以及这种效应是否会由波反射对中心动脉压的影响介导。在68例终末期肾病患者中，我们检测了血压、臂踝脉搏波速度以及左颈总动脉的增强指数，后者是波反射对中心动脉收缩峰影响的一种测量指标。通过斑块评分和最大内膜中层厚度对颈动脉粥样硬化程度进行量化。采用超声心动图测定左心室质量指数。在简单回归分析中，臂踝脉搏波速度与斑块评分和最大内膜中层厚度均相关（分别为r = 0.420，p < 0.001和r = 0.452，p < 0.0005），但与左心室质量指数无关。以斑块评分或最大内膜中层厚度为因变量，臂踝脉搏波速度和已知临床危险因素为自变量进行多元回归分析。臂踝脉搏波速度是斑块评分（β = 0.006，p = 0.004）和最大内膜中层厚度（β = 0.008，p = 0.04）的独立危险因素。左心室质量指数的独立危险因素是左心室舒张内径（β = 3.509，p = 0.000007）和增强指数（β = 0.580，p = 0.04）。终末期肾病患者的臂踝脉搏波速度与增强指数无关。总之，发现较高的臂踝脉搏波速度是终末期肾病患者颈动脉粥样硬化的危险因素；这种效应独立于波反射对中心动脉压的影响。臂踝脉搏波速度与左心室结构无关。
