區段血管硬化在保存性收縮功能暨中度至高度心血管風險族群與B型排鈉利尿胜肽之關聯性研究

Segmental Arterial Stiffness in Relation to B type Natriuretic Peptide with Preserved Systolic Function in Intermediate-to-high Risk Patients

顏志軒(Chih-Hsuan Yen)

指導教授 ： 簡國龍

國立臺灣大學/公共衛生學院/流行病學與預防醫學研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.00019

摘要

背景
中央動脈硬化已知在許多心血管疾病中扮演重要角色。然而，有關不同區段之血管動脈硬化脈波速 ( PWV) 與B型排鈉利尿胜肽 (BNP) 之相關性研究仍有許多未知之處。
材料與方法
本研究自2009至2011年總共研究了一千二百五十五名 (平均年齡六十二點六歲；百分之四十七點八為男性)中度至重度心血管危險性 (大於等於兩個危險因子) 且保存性左心室收縮射出分率的個體。使用日本歐姆龍公司 VP-2000 機器評估不同區段之血管動脈硬化脈波速 (心股區段 hf-PWV、臂踝區段 ba-PWV、心頸區段 hc-PWV) 並使用機器檢驗血液中B型排鈉利尿胜肽濃度。
結果
將所有參與者依照心股區段血管動脈硬化脈波速分成四分位，高的心股區段血管動脈硬化脈波速有明顯較大的年紀、較多的女性、較差的腎功能、較高的血壓值及左心室心肌質量參數，以及較高的B型排鈉利尿胜肽濃度指數(P值皆小於0.05)。心股區段血管動脈硬化脈波速與B型鈉利尿胜肽濃度相關性最好(相關係數=0.28，檢定結果P值小於0.01)。經過多變量迴歸分析校正，心股區段與臂踝區段血管動脈硬化脈波速皆與較高的B型排鈉利尿胜肽濃度相關(beta-值相對應心股區段、臂踝區段分別為8.3, 6.4，檢定結果P值皆小於0.01) 。外加於左心室心肌質量參數，心股區段與臂踝區段血管動脈硬化脈波速分別可多提供預測較高B型排鈉利尿胜肽濃度指數 (>100 pg/ml)的效應(C 統計量分別從0. 63 增至0.71與0.63 增至0.69， P值皆小於0.01) 但只有心股區段血管動脈硬化脈波速可增加0.7%再分組後改善預測B型排鈉利尿胜肽濃度機率(P值等於0.029)。

結論
我們的研究報告指出區段血管動脈硬化脈波速與較高的B型排鈉利尿胜肽濃度相關。不同區段血管動脈硬化脈波速代表不同影響且與心肌過度壓力負荷有臨床上的相關性。

關鍵字

血管動脈硬化 ； 脈波速 ； B型排鈉利尿胜肽 ； 保存性收縮功能

並列摘要

Background:
Central arterial stiffness had been shown to play a key role in cardiovascular diseases. However, evidence regarding such arterial stiffness from various arterial segments in relation to B type natriuretic peptide (BNP) remained elusive.

Materials and methods:
The project consecutively studied 1255 participants (mean±SD age: 62.6±12.3 years, 47.8% men) with preserved left ventricular ejection fraction (LVEF)>=50% and at least two risk factors. Arterial pulse wave velocity (PWV) was measured by an automatic device (VP-2000; Omron Healthcare, Japan) for heart-femoral (hf-PWV), brachial-ankle (ba-PWV), and heart-carotid (hc-PWV) segments. BNP concentrations were measured.

Results:
Participants in the highest quartile of hf-PWV were older, more female percentage, worse renal function, higher blood pressure, left ventricule mass index (LVMI) and serum BNP level, compared with those in the lowest quartile (all P<0.05). Hf-PWV was strongest associated with elevated serum BNP (r=0.28, p<0.01). Both hf-PWV and ba-PWV were related to elevated serum BNP level after adjusted (beta coefficient= 8.3, 6.4 respectively, both P<0.01). Adding both hf-PWV and ba-PWV to LVMI, the area under receiver operating curve were respectively increased from 0.63 to 0.71 and from 0.63 to 0.69 significantly (p<0.01) to predicting high BNP (>100 pg/ml) but only hf-PWV had significant better 0.7% ability to predict a high BNP concentration (P=0.029).

Conclusion:
Our study showed that significant segmental PWV was associated with BNP concentration, implying that arterial stiffness was associated with the myocardial pressure overload.

並列關鍵字

Arterial stiffness ； Pulse wave velocity ； B type natriuretic peptide ； preserved EF function

參考文獻

1. Mitchell GF, Hwang SJ, Ramachandran SV, Larson MG, Pencina MJ, Hamburg NM, Vita JA, Levy D, Benjamin EJ. Arterial stiffness and Crdiovascular Events The Framinghan Heart study. Circulation 2010;121:505-11.

2. Tang WHW, Francis GS. The year in heart failure. J Am Coll Cardiol 2008;52:1671-8.

4. Bueno H, Ross JS, Wang Y, Chen J, Vidan MT, Normand SLT, Curtis JP, Drye EE, Lichtman JH, KeenanPS, Kosiborod M, Krumholz HM. Trends in length of stay and short-term outcomes among medicare patients hospitalized for heart faiure, 1993-2006. JAMA 2010;303:2141-7.

5. Zile MR. New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part I: Diagnosis, Prognosis, and Measurements of Diastolic Function. Circulation 2002;105:1387-93.

6. Gustafsson F. Long-term survival in patients hospitalized with congestive heart failure: relation to preserved and reduced left ventricular systolic function. Eur Heart J 2003;24:863-70.