【作者】 孟岩；

【导师】 王丽娟；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2025， 硕士

【摘要】 背景:动脉粥样硬化已成为导致多种心脑血管事件的重要病理基础,其早期检测与精准评估对于预防和干预心脑血管疾病具有重要意义。脉搏波传导速度(pulse wave velocity,PWV)作为反映动脉弹性和僵硬程度的无创指标,已被广泛应用于全身及局部动脉硬化的评估研究。超快超声技术作为一种新兴测量PWV的技术,具有操作简便、实时性强等优点,能够在短时间内获取高质量的脉搏波信号并通过先进的处理算法实现高精度计算。然而目前对超快超声测量PWV的研究尚未完全成熟,尤其与颈动脉粥样硬化程度之间的关系仍未明确。本研究旨在利用超快超声技术进行PWV的测量,探讨其与颈动脉粥样硬化程度之间的关系,为早期识别颈动脉硬化提供科学依据和技术支持。方法:收集自2023年3月到2024年1月于吉林大学第一医院神经内科彩超门诊就诊的住院及门诊患者,收集患者既往情况及常规检查指标。运用常规超声检查患者双侧颈动脉斑块及狭窄情况,运用超快超声测量患者双侧颈总动脉的超快脉搏波传导速度(ultrafast pulse wave velocity,ufPWV)。记录患者双侧总斑块数量并分为无斑块、1个斑块、2个斑块及≥3个斑块组;按照动脉狭窄情况分为轻度、中度和重度血管狭窄组。最后运用SPSS软件对获得的所有数据进行统计学分析。结果:1、患者临床基线数据分析:最终有448例患者纳入本研究,共有男性患者236例(52.7%),患者平均年龄为64(58-69)岁,其中既往高血压236例(52.7%),糖尿病113例(25.2%),冠心病91例(20.3%),高脂血症183例(40.8%),缺血性卒中/短暂性脑缺血发作(transient ischemic attack,TIA)117例(26.1%)。既往服用降压药患者101例(22.5%),降糖药44例(9.8%),降脂药140例(31.3%),抗血小板药物143例(31.9%)。患者接受超声检查时收缩压平均为131(121-145)mm Hg,舒张压为80(75-88)mm Hg,心率为70(69-76)次/分。患者平均体重指数(body mass index,BMI)为24.21(22.31-26.55)kg/m~2。存在神经功能障碍症状的患者204例(45.5%)。2、患者影像学基线数据分析:患者平均ufPWV为8.03(7.13-9.27)m/s。其中共有350例(78.1%)患者存在颈动脉斑块,存在1个斑块患者55例(12.3%),存在2个斑块患者62例(13.8%),存在3个及以上斑块患者233例(52.0%)。共有191例患者存在颈动脉狭窄(42.6%),轻度血管狭窄患者66例(14.7%),中度血管狭窄患者53例(11.8%),重度血管狭窄72例(16.1%)。3、超快脉搏波传导速度的相关因素:年龄(r=0.342)、高血压(r=0.343)、收缩压(r=0.389)、颈动脉存在斑块(r=0.371)与ufPWV呈低程度相关,而冠心病(r=0.120)、高脂血症(r=0.283)、缺血性卒中/TIA(r=0.105)、BMI(r=0.098)、颈动脉存在狭窄(r=0.276)与ufPWV有较弱程度的相关。4、超快脉搏波传导速度与颈动脉斑块之间的关联:单因素回归分析中男性、年龄、高血压、糖尿病、冠心病、高脂血症、缺血性卒中/TIA、吸烟史、饮酒史、降糖药用药史、降压药用药史、降脂药用药史、抗血小板药物用药史、BMI、收缩压、ufPWV均与颈动脉存在斑块有着较为显著的统计学意义(P<0.05)。调整混杂因素后进行多因素回归分析得出,年龄、高血压、高脂血症、吸烟史、降脂药用药史及ufPWV是颈动脉存在斑块的独立危险因素(P<0.05)。将ufPWV与其他危险因素同分组后的颈动脉斑块之间进行多元逻辑回归分析,以无斑块组作为对照,在调整混杂因素后,ufPWV与每个斑块分组中的颈动脉斑块数量均呈正相关。将3个斑块组分别与无斑块组两两比较得出,1个斑块、2个斑块和3个及以上斑块组中ufPWV的优势比(odds ratio,OR)值(95%置信区间[confidence interval,CI])为1.702(1.227-2.361)、1.545(1.120-2.131)和1.773(1.310-2.399),且每个斑块分组中ufPWV均有明显的统计学意义(P<0.05)。5、超快脉搏波传导速度与颈动脉狭窄的关联:将ufPWV与其他危险因素同是否存在颈动脉狭窄之间进行二元逻辑回归分析。单因素回归分析中男性、年龄、高血压、糖尿病、冠心病、高脂血症、缺血性卒中/TIA、吸烟史、饮酒史、降脂药用药史、抗血小板药物用药史、收缩压、ufPWV均与颈动脉存在狭窄有着较为显著的统计学意义(P<0.05)。调整混杂因素后进行多因素回归分析后得出,高血压、糖尿病、高脂血症、缺血性卒中/TIA、吸烟史及ufPWV是血管狭窄独立危险因素(P<0.05)。6、超快脉搏波传导速度与不同血管狭窄程度之间的关联:将颈动脉狭窄程度分成轻度血管狭窄组、中度血管狭窄组以及重度血管狭窄组,在3组之间进行组间比较。男性、高脂血症、饮酒史、抗血小板用药史、ufPWV这些变量在3个组之间存在显著差异(P<0.05)。将ufPWV与其他危险因素同分组后的颈动脉狭窄程度进一步行多元逻辑回归分析。以轻度血管狭窄组作为对照组,在调整混杂因素后,ufPWV与每个血管狭窄程度均呈正相关。与轻度血管狭窄组相比,中度血管狭窄组及重度血管狭窄组的OR值(95%CI)分别为1.376(1.026-1.846)、1.893(1.423-2.517),且每个血管狭窄分组中ufPWV均有明显的统计学意义(P<0.05)。7、超快脉搏波传导速度与神经功能障碍症状之间的关联:将ufPWV与其他危险因素同是否存在神经功能障碍的症状之间进行二元逻辑回归分析。在单因素回归分析中男性、年龄、高血压、糖尿病、冠心病、高脂血症、缺血性卒中/TIA、吸烟史、饮酒史、降脂药用药史、抗血小板药物用药史、BMI、收缩压、ufPWV、存在颈动脉斑块及存在颈动脉狭窄这些因素均与颈动脉存在神经功能障碍症状有着较为显著的统计学意义(P<0.05)。调整了混杂因素后进行多因素回归分析得出,降脂药用药史、ufPWV以及颈动脉存在狭窄是存在神经功能障碍症状的独立危险因素(P<0.05)。结论:ufPWV是评估局部颈动脉粥样硬化的可行性指标,ufPWV的值升高,颈动脉出现斑块的风险越大,斑块数量增加的可能性越高,颈动脉出现狭窄的可能性也越高。ufPWV值的升高与颈动脉狭窄程度增加相关,并与神经功能障碍症状的出现或加重相关。超快超声测量脉搏波传导速度作为一种新技术,可能在评估动脉粥样硬化中具有重要临床意义。更多还原

【Abstract】 Background:Atherosclerosis has become an important pathological basis leading to a variety of cardiovascular and cerebrovascular events,and its early detection and precise assessment are important for the prevention and intervention of cardiovascular and cerebrovascular diseases.As a noninvasive indicator of arterial elasticity and stiffness,pulse wave velocity(PWV)has been widely used in systemic and local atherosclerosis assessment studies.Ultrafast ultrasound,as an emerging technology for PWV measurement,has the advantages of easy operation and real-time performance,and is capable of acquiring high-quality PWV signals in a short period of time and achieving high-precision calculations through advanced processing algorithms.However,the study of PWV measured by ultrafast ultrasound is not yet fully mature,especially the relationship with the degree of carotid atherosclerosis has not yet been clarified.The aim of this study is to utilize ultrafast ultrasound technology for PWV measurement to investigate the relationship between PWV and the degree of carotid atherosclerosis,and to provide scientific evidence and technical support for the early identification of carotid atherosclerosis.Methods:Inpatient and outpatient patients undergoing the color ultrasound clinic of the Department of Neurology of the First Hospital of Jilin University from March 2023 to January 2024 were enrolled,with collection of medical histories and routine laboratory parameters.The patients were examined for bilateral carotid plaque and stenosis using conventional ultrasound,and the PWV of bilateral common carotid arteries was measured using ultrafast ultrasound(ufPWV),and the total number of bilateral plaques was recorded and stratified into groups of no plaque,1 plaque,2plaques,and≥3 plaques;and the patients were categorized into the groups of mild,moderate,and severe stenosis according to the stenosis condition.Finally,all data obtained were statistically analyzed using SPSS software.Results:1.Analysis of patients’clinical baseline data:448 patients were finally enrolled in this study,with a total of 236(52.7%)male patients and a mean age of 64(58-69)years,including 236(52.7%)cases of previous hypertension,113(25.2%)cases of diabetes mellitus,91(20.3%)cases of coronary artery disease,183(40.8%)cases of hyperlipidemia,117(26.1%)cases of ischemic stroke/transient ischemic attack(TIA),and 117(26.1%)cases of ischemic stroke/transient ischemic attack(TIA).There were113 cases(25.2%)of diabetes mellitus,91 cases(20.3%)of coronary heart disease,183 cases(40.8%)of hyperlipidemia,and 117 cases(26.1%)of transient ischemic attack(TIA).There were 101 patients(22.5%)previously taking antihypertensive drugs,44 patients(9.8%)taking hypoglycemic drugs,140 patients(31.3%)taking lipid-lowering drugs,and 143 patients(31.9%)taking antiplatelet drugs.The mean systolic blood pressure at the time the patients underwent ultrasound was 131(121-145)mm Hg,diastolic blood pressure was 80(75-88)mm Hg,and heart rate was70(69-76)beats/minute.The mean body index(BMI)of the patients was 24.21(22.31-26.55)kg/m2.Symptoms of neurological disorders were present in 204patients(45.5%).2.Patients’baseline imaging data were analyzed:the mean ufPWV of patients was 8.03(7.13-9.27)m/s.A total of 350 patients(78.1%)had carotid plaques,55patients(12.3%)had 1 plaque,62 patients(13.8%)had 2 plaques,and 233 patients(52.0%)had 3 or more plaques.A total of 191 patients had carotid stenosis(42.6%),66 patients with mild stenosis(14.7%),53 patients with moderate stenosis(11.8%),and 72 patients with severe stenosis(16.1%).3.Correlates of ultrafast pulse wave velocity:age(r=0.342),hypertension(r=0.343),systolic blood pressure(r=0.389),and the presence of plaque in the carotid arteries(r=0.371)were showed low-grade correlation with ufPWV,whereas coronary artery disease(r=0.120),hyperlipidemia(r=0.283),and ischemic stroke/TIA(r=0.105)were,BMI(r=0.098),and the presence of carotid artery stenosis(r=0.276)were showed weak correlations with ufPWV.4.Association between ultrafast pulse wave velocity and carotid plaque:in univariate regression analysis male,age,hypertension,diabetes mellitus,coronary artery disease,hyperlipidemia,ischemic stroke/TIA,history of smoking,history of alcohol consumption,history of glucose-lowering drugs,history of antihypertensive drugs,history of lipid-lowering drugs,history of antiplatelet drugs,BMI,systolic blood pressure,and ufPWV had a more statistically significant associations with the presence of carotid artery plaque(P<0.05).After adjusting for confounders,multifactorial regression analysis revealed that age,hypertension,hyperlipidemia,smoking history,history of lipid-lowering drug use,and ufPWV were independent risk factors for the presence of plaque in the carotid artery(P<0.05).Multiple logistic regression analysis was performed between ufPWV and other risk factors with carotid plaques in the same subgroups.ufPWV was positively correlated with the number of carotid plaques in each plaque subgroup after adjusting for confounders,using the no-plaque group as a control.A two-by-two comparison of the 3 plaque groups with the no-plaque group showed that the odds ratio(OR)(95%confidence interval,[CI])of ufPWV in the 1-plaque,2-plaque,and 3-or-more-plaque groups were 1.702(1.227-2.361),1.545(1.120-2.131),and 1.773(1.310-2.399),and the OR(95%CI)for ufPWV were statistically significant(P<0.001)for ufPWV in each plaque group.5.Association of ultrafast pulse wave velocity with carotid artery stenosis:a binary logistic regression analysis was performed between ufPWV with other risk factors and the presence of carotid artery stenosis.In univariate regression analysis,male,age,hypertension,diabetes mellitus,coronary heart disease,hyperlipidemia,ischemic stroke/TIA,history of smoking,history of alcohol consumption,history of lipid-lowering medications,history of antiplatelet medications,systolic blood pressure,and ufPWV were statistically significantly associated with the presence of carotid artery stenosis(P<0.05).After adjusting for confounders,multifactorial regression analysis revealed that hypertension,diabetes mellitus,hyperlipidemia,ischemic stroke/TIA,smoking history,and ufPWV were independent risk factors for stenosis(P<0.05).6.Association between ultrafast pulse wave velocity and different degrees of stenosis:The degree of carotid stenosis was categorized into mild stenosis,moderate stenosis,and severe stenosis groups,and between-group comparisons were made between the 3 groups.The variables of male,hyperlipidemia,history of alcohol consumption,history of antiplatelet medication,and ufPWV were significantly different between the 3 groups(P<0.05).The degree of carotid stenosis after grouping ufPWV with other risk factors was further analyzed by multivariate logistic regression.Using the mild stenosis group as the control group,ufPWV was positively associated with the degree of stenosis in each vessel after adjusting for confounders.Compared with the mild stenosis group,the OR(95%CI)of the moderate stenosis group and the severe stenosis group were1.376(1.026-1.846)and 1.893(1.423-2.517),respectively,and ufPWV was statistically significant in each stenosis group(P<0.05).7.Association between ultrafast pulse wave velocity and Symptoms of neurological disorders:a binary logistic regression analysis was performed between ufPWV with other risk factors and the presence of signs or symptoms of neurologic deficits.In univariate regression analysis,male,age,hypertension,diabetes mellitus,coronary artery disease,hyperlipidemia,ischemic stroke/TIA,history of smoking,history of alcohol consumption,history of lipid-lowering drugs,history of antiplatelet drugs,BMI,systolic blood pressure,ufPWV,the presence of carotid artery plaque and the presence of carotid artery stenosis were statistically significant(P<0.05)in association with the presence of neurological disorders in carotid arteries.significance(P<0.05).After adjusting for confounders,multifactorial regression analysis showed that history of lipid-lowering drug use,ufPWV,and the presence of carotid artery stenosis were independent risk factors for the presence of neurological disorders symptoms or signs(P<0.05).Conclusion:ufPWV demonstrates clinical utility as a biomarker for assessing localized carotid atherosclerosis.ufPWV values are higher the risk of the presence of plaque in the carotid arteries,the higher the likelihood of an increase in the number of plaques,and the higher the likelihood of stenosis of the carotid arteries.ufPWV values are correlated with an increase in carotid arterial stenosis,and shows significant association with the progression or exacerbation of symptoms of neurological disorders.Ultrafast ultrasound measurement of ufPWV as a new technique may be clinically important in the assessment of atherosclerosis.更多还原