目的:我们建议:1)特发性肺动脉高压(IPAH)患者有积极的因素,这些因素不仅会损害肺动脉,也会损害全身动脉;2)如果存在这些变化,它们可能与影响预后的其他参数相关。这项研究是首次尝试使用心踝血管指数(CAVI)评估IPAH患者的全身动脉僵硬度。
方法:总共112例患者被纳入研究:第1组包括45例新诊断为IPAH的患者,第2组包括32例动脉高血压患者,对照组为35名按年龄调整的健康人。右心导管插入术,心电图,6分钟步行测试(6MWT),超声心动图,血压(BP)测量和动态血压监测,脉搏波弹性动脉僵硬度(PWVe;颈-股动脉段)和肌动脉僵硬度(PWVm;颈-桡动脉段),CAVI,并提供N末端B型利钠肽原(NT-proBNP)水平。斯皮尔曼相关性,我们进行了线性回归和多变量二元逻辑分析,以确定与PWV和CAVI相关的预测因子.
结果:对影响动脉僵硬度的主要特征进行校正。IPAH患者的6MWT距离明显较短(P<0.001),Borg呼吸困难评分明显高于动脉高血压患者(收缩压/舒张压BP=146.1±10.7/94.2±9.8mmHg)和对照组=330.2±14.6vs523.8±35.3和560.9±30.2m,分别为6.2±1.8vs1.2±2.1和0.9±2.8分。高血压患者的PWVm和PWVe最高(10.3±1.5和11.42±1.70m/s)。对照组与IPAH组主动脉BP无显著性差异,但IPAH患者的PWVm/PWVe值显着(P<0.003/0.008)高于对照组(8.1±1.9/8.49±1.92vs6.63±1.34/7.29±0.87m/s)。健康受试者两侧CAVIs均明显降低(5.91±0.99/5.98±0.87右/左)。与对照组相比,IPAH患者的CAVI与动脉高血压患者没有差异(7.40±1.32/7.22±1.32vs7.19±0.78/7.2±1.1PWVe),除尿酸外,其他任何参数均无相关性。PWVm与尿酸相关(r=0.58,P<0.001),在Spearman分析中,NT-proBNP(r=0.33,P=0.03)和男性(r=0.37,P=0.013),但不是在多因素线性回归分析中。CAVI与年龄和表征功能容量(6MWT距离)和右心室功能(NT-proBNP,TAPSE)在Spearman分析中,与年龄和TAPSE在多因素线性回归分析中。在二元logistic回归分析中,右侧和/或左侧CAVI>8.0与年龄相关,6MWT距离,TAPSE,但仅与年龄(β=1.104,P=0.008,CI1.026-1.189)和TAPSE(β=0.66,P=0.016,CI0.474-0.925)相关。
结论:尽管血压水平相等且处于正常范围,年龄校正后的IPAH患者的动脉明显比健康人更硬,与动脉高血压患者相当.通过CAVI评估IPAH患者的动脉僵硬度与年龄和TAPSE相关。根据我们的结果,不可能得出IPAH患者动脉硬化的发病机理,但是发现的变化和相关性为进一步研究提供了新的方向,包括发病机制和预后研究。
OBJECTIVE: We suggested: 1) patients with idiopathic pulmonary hypertension (IPAH) have active factors which could damage not only the pulmonary but systemic arteries too as in arterial hypertensive patients; 2) if these changes were present, they might correlate with other parameters influencing on the prognosis. This study is the first attempt to use cardio-ankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH.
METHODS: A total of 112 patients were included in the study: group 1 consisted of 45 patients with new diagnosed IPAH, group 2 included 32 patients with arterial hypertension, and in the control group were 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe; segment carotid-femoral arteries) and muscular artery stiffness (PWVm; segment carotid-radial arteries), CAVI, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI.
RESULTS: The groups were adjusted for principal characteristics influenced on arterial stiffness. IPAH patients had significantly (P<0.001 for all) shorter 6MWT distance and higher Borg dyspnea score than the patients with arterial hypertension (systolic/diastolic BP = 146.1±10.7/94.2±9.8 mmHg) and the control group = 330.2±14.6 vs 523.8±35.3 and 560.9±30.2 m respectively and 6.2±1.8 vs 1.2±2.1 and 0.9±2.8 points. The PWVm and PWVe were the highest in hypertensive patients (10.3±1.5 and 11.42±1.70 m/s). The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significantly (P<0.003/0.008) higher in IPAH patients than in the control group (8.1±1.9/8.49±1.92 vs 6.63±1.34/7.29±0.87 m/s). The CAVIs on both sides were significantly lower in the healthy subjects (5.91±0.99/5.98±0.87 right/left side). Patients with IPAH did not differ from the arterial hypertension patients by CAVIs in comparison with the control group (7.40±1.32/7.22±1.32 vs 7.19±0.78/7.2±1.1 PWVe) did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r=0.58, P<0.001), NT-proBNP (r=0.33, P=0.03) and male gender (r=0.37, P=0.013) at Spearman analysis, but not at multifactorial linear regression analysis. The CAVI correlated with age and parameters characterized functional capacity (6MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI > 8.0 at right and/or left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (β=1.104, P=0.008, CI 1.026-1.189) and TAPSE (β=0.66, P=0.016, CI 0.474-0.925).
CONCLUSIONS: In spite of equal and at normal range BP level, the age-adjusted patients with IPAH had significantly stiffer arteries than the healthy persons and they were comparable with the arterial hypertensive patients. Arterial stiffness evaluated by CAVI correlated with age and TAPSE in IPAH patients. Based on our results it is impossible to conclude the pathogenesis of arterial stiffening in IPAH patients, but the discovered changes and correlations suggest new directions for further studies, including pathogenesis and prognosis researches.