背景:颈动脉内中膜厚度(IMT)和直径,刚度,和波反射,是心血管疾病的独立和重要的临床生物标志物和风险预测因子。本研究的目的是为健康的中国成年人建立全国范围的颈动脉特性参考值,并探索潜在的临床决定因素。
方法:在2021年4月至2022年7月期间,共有3053名18-79岁的健康汉族成年人(1922名女性)在中国28个合作的三级中心注册。通过射频(RF)超声系统实现了颈总动脉壁的实时跟踪。IMT,直径,顺应性系数,β刚度,局部脉搏波速度(PWV),局部收缩压,增强压力(AP),然后自动测量和报告增强指数(AIX)。数据按年龄组和性别分层。通过Jonckheere-Terpstra检验和简单线性回归分析年龄与颈动脉性质参数之间的关系。颈动脉特性的主要临床决定因素通过皮尔逊相关性确定,多元线性回归,以及协方差分析。
结果:颈动脉特性的所有参数均显示出与年龄相关的显着轨迹。女性显示出更薄的IMT,颈动脉直径较小,较大的AP,和AIX比男人。40岁前男性的β硬度和PWV明显高于女性,但在那之后,差异发生了逆转。男女颈动脉IMT(女性5.5μm/年,男性5.8μm/年)和直径(男女0.03mm/年)的增加率相似。对于刚度和波反射,女性与年龄相关的变异显著大于男性,回归斜率更陡(性别交互作用对年龄的所有P<0.05).血压,体重指数(BMI),根据年龄和性别的调整,甘油三酯水平被确定为颈动脉特性的主要临床决定因素。
结论:建立了健康中国成年人通过RF超声测量的颈动脉特性的年龄和性别特定参考值。血压,BMI,和甘油三酯水平应考虑为临床应用提供相应的参考值。
BACKGROUND: Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.
METHODS: A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout
China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson\'s correlation, multiple linear regression, and analyses of covariance.
RESULTS: All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex.
CONCLUSIONS: The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.