大动脉结构与功能检测的意义课件

大动脉结构与功能检测的意义 Ankle-Brachial blood pressure Index (ABI),上海交通大学医学院附属瑞金医院 上海市高血压研究所 王继光 ,大动脉结构与功能检测的意义 大动脉结构与功能检测的方法 ABI,常见动脉血管结构病变,动脉粥样硬化(atherosclerosis)：动脉血管壁的脂肪性变，高脂血症是最重要原因，多有明显的斑块形成。严重时，可导致管腔狭窄、甚至闭塞，引起心肌梗死、脑梗死等严重疾病； 动脉硬化(arteriosclerosis)：主要是动脉壁特别是中膜增后 、纤维化(胶元蛋白) ，老化、高血压是主要原因，主要表现为内中膜增厚(IMThickening)，管腔变小，管腔（lumen）与管壁（wall）的比例；,动脉血管功能病变-弹性功能下降,动脉粥样硬化斑块：机械性功能紊乱; 动脉硬化：弹性（ elasticity ）功能 ; 动脉血管壁的张力（Wall stress）: 血压: 血压 ，僵硬度 （ stiffness ），弹性功能； 血管壁本身的张力: 不同降压药物，血压 相似，僵硬度 可以明显不同。 一个新的概念: 血管功能衰竭 (Vascular dysfunction or failure),150,100,50,150,100,50,150,100,50,(mmHg),Age 68 years,Age 54 years,Age 24 years,Renal artery,aorta,Thoracic aorta,Ascending aorta,Abdominal,lliac artery,Femoral artery,(mmHg),(mmHg),Ono K, et al. J Am Soc Nephrol. 2003;14:1591-8.,ABI与总死亡率及心血管死亡率,ABI 1.1-1.3 1.3 1.0-1.1 0.9-1.0 0.9,随访天数,0,ABI 1.1-1.3 1.3 1.0-1.1 0.9-1.0 0.9,总生存比例,心血管生存比例,Willum Hansen, T. et al. Circulation 2006;113:664-670,PWV与绝对心血管风险,主动脉 PWV (m/s),10年心血管风险 (%),女性 n=800,男性 n=878,120 110 100 90 80,120 110 100 90 80,MAP,MAP,Markers of organ damage: ESH-ESC guidelines,CV predictive Availability Cost value Electrocardiography + + + Echocardiography + + + Carotid IMT + + + Arterial stiffness (PWV) + + + ABI + + + Coronary calcium content + + +,J Hypertens 2007;25:1105-87.,大动脉结构与功能检测的意义 大动脉结构与功能检测的方法 ABI,大动脉结构检测,Plaques Imaging (invasive, MRI, CT, and ultrasounic) ABI (Doppler, auscultatory, and oscillometric) IMT Carotid (common, bifurcation, and internal) Femoral (common) Brachial,大动脉功能检测,Systemic PWV (carotid-femoral, carotid-brachial, or brachial-ankle) Systolic augmentation/wave reflections (AI) Ambulatory Arterial Stiffness Index (AASI) Pulse pressure Local Compliance V / P Distensibility V / (PV0),ART.LAB The Arterial Analyser,Blood vessel wall thickness RFQIMT,Brightness mode scanning (B-mode),Frame rate 30 frames/s,Assessment of:,Arterial stiffness RFQCS,Wall motion mode scanning (WM-mode),Frame rate 660 frames/s,Assessment of:,ART.LAB The Arterial Analyser,OMRON Colin VP-1000,Pulse wave velocity and ABI,Pulse wave velocity (brachial-ankle) Ankle-brachial index Optional: carotid-femoral PWV and other PWVs,大动脉结构与功能检测的意义 大动脉结构与功能检测的方法 ABI,ABI,ABI,Ankle-brachial index (ABI),Definition: SBP at ankle / SBP at brachial Thresholds for the diagnosis of stenosis of arteries at the lower extremities:,0.5,0.7,0.9,1.0,Severe moderate mild borderline healthy PAD,上臂血压平均值（mm Hg）,男性 女性 P (n=465) (n=481) 听诊收缩压 130.4 130.8 0.79 示波法收缩压 133.4 133.5 0.96 听诊舒张压 78.6 78.9 0.71 示波法舒张压 77.7 77.3 0.68,Pan CR, et al. Hypertension Res 2007;30:555-561.,踝部血压平均值（mm Hg）,男性 女性 P (n=465) (n=481) 多普勒法收缩压 150.4 148.3 0.26 听诊收缩压 141.0 138.7 0.23 示波法收缩压 154.4 148.4 0.002 听诊舒张压 80.8 82.0 0.14 示波法舒张压 80.0 79.0 0.23,Pan CR, et al. Hypertension Res 2007;30:555-561.,ABI的分布情况（1）,Cumulative distribution (%),Doppler (n=481) Auscultatory (n=432) Osicillometric (n=481),100,80,60,40,20,0,Men,Doppler (n=465) Auscultatory (n=448) Osicillometric (n=465),Ankle-brachial blood pressure index,100,80,60,40,20,0,Women,Pan CR, et al. Hypertension Res 2007;30:555-561.,SCHS: Distributions of ABI by sex,Percentage of subjects (%),Ankle-brachial index,No. of events,Event,Hazards ratio (95% CL),0.5,1,2,Uadjusted All-cause mortality Non-cancer motality Adjusted All-cause mortality Non-cancer motality,4,8,*Cutoff limit of the bottom decile. For age, sex, current smoking, alcohol intake, systolic and diastolic pressure, diabetes mellitus, and hypertension treatment. Mean follow-up time was 1.9 yeasr.,2.53 (1.50-4.27) 2.87 (1.50-4.27) 1.70 (0.99-2.93) 1.68 (0.86-3.31),SCHS: All-cause and non-cancer mortali