基于粘弹性指标来评价早期动脉硬化的一种新方法的研究

Cardiovascular disease and cerebral vascular disease are the major causes of mortality in developed countries, and are strongly associated with atherosclerosis. Identification of such abnormalities and risks in accessible arteries is the conventional method for early detection of presymptomatic vascular disease, allowing timely application of preventive measures and helping to prevent further damage to the circulatory system. Accordingly, the ability to quantitatively evaluate the dynamic characteristics of arteries without unnatural stimulation would allow estimation of the internal condition of arterial endothelial function not only in the medical field but also during common activities in daily healthcare. A number of methods relating to arteriosclerosis have been evaluated based on arterial elastic properties such as pulse wave velocity (PWV), arterial elasticity, arterial compliance, and the augmentation index. However, consideration of arterial elastic properties is useful for quantification rather than as an atherosclerosis precaution..Against such a background, this project outlines a novel non-invasive method to evaluate the dynamic characteristics of arterial wall response in reactive hyperemia. The proposed intravascular pressure-dependent arterial viscoelastic indices were determined using non-invasive arterial pressure and strain-gauge plethysmography on the forearm during reactive hyperemia. To investigate the validity of the proposed method, it was compared to the conventional PWV method, and age-related changes in endothelial function were evaluated.The proposed arterial viscoelastic indices were found to be highly correlated with age. The differing arterial viscoelasticity behavior seen suggests that intrinsic mechanisms related to vascular tone and vasomotion might be involved in the oscillatory pattern of the arterial wall. The proposed strain-gauge plethysmography technique is applicable to non-invasive assessment of endothelial function as an alternative low-cost approach with less dependence on intravascular pressure, and suitable for community use to meet various demand, and that it is also helpful in the early detection of diseases. The technique offers definite cost benefits in terms of both hardware and manpower. In consideration of these collective merits, we believe that the described method has the capacity for useful application in non-invasive studies of the vascular system.

心血管疾病是当今世界死亡率最高的疾病，并与动脉硬化密切相关。如果可以检测出血管的早期病变，及时采取预防措施，有利于防止循环系统进一步损害。无创性测量能够定量评价动脉的动态特性，不仅可以利用在医疗领域，也可以用在日常生活中血管状态的评估。目前，已有基于脉搏波信号来评价动脉硬化的一些方法，如：动脉脉搏波速度（PWV）、反射波增益指数（AI）等。然而这些参数只能诊断动脉硬化的后期阶段，考虑动脉弹性特征有益于发现早期的病变。本项目提出了一种新型的无创性方法，可以评价动脉血管壁的动态特性变化。所提出的血管粘弹性指数计算方法是，把反应性充血实验中的无创性血压和前臂应变容积描记参数，代入血管模型而得出来的。探讨该方法的有效性，与传统的PWV法比较，并评价年龄所引起的血管内皮功能的变化。拟提出的无创性评估血管内皮功能的技术，作为一种低成本的替代方法，将在社区医疗卫生机构预防慢性心血管疾病中起着重要的作用。

根据世界卫生组织的报告，心血管疾病仍然是发展中国家中引起死亡的主要原因之一，这主要与动脉粥样硬化密切相关。动脉内皮细胞在动脉粥样硬化斑块和心血管疾病的发展过程中起着主要作用，早期发现心血管疾病可以及时发现预防措施，并能帮助防止进一步损害循环系统。如果用`无创性方法可以检测出血管内皮功能的早期病变，及时采取预防措施，有利于防止循环系统进一步损害。无创性测量能够定量评价动脉的动态特性，不仅可以利用在医疗领域，也可以用在日常生活中血管状态的评估。在这样的背景下，本项目提出了一种新型的无创性测量方法方法，可以评价在反应性充血中的动脉血管壁的动态响应特性的变化。经考虑血管的应变和血管内压力非线性关系，提出了一种新的对数线性化的动脉粘弹性模型，可以评价血管的动态特性参数，如刚度和粘度。该模型中，使用最小二乘法通过同时测得的动脉位移波和无创性的血压波形计算出每一次心搏中的动脉粘弹性指标（刚度和粘度），它不受血管内压力的影响。所提出的血管内压力无依赖性血管粘弹性指数计算方法是，使用应变容积描记波和无创性血压值代入血管壁模型，计算出反应性充血实验中每一次心搏中的血管的硬度指标“血管粘弹性指数（刚性，粘性）。探讨该方法的有效性，评价年龄所引起的血管内皮功能的变化并与传统的PWV法进行了比较。结果显示青年组和老年组间粘弹性指数刚性（P<0.05）和 粘性（P <0.05）的有显著差异，PWV的往往要在青年人群中低，但两组间没有差异（P=0.22）。拟提出的无创性评估血管内皮功能的技术，作为一种低成本的替代方法，将在社区医疗卫生机构预防慢性心血管疾病中起着重要的作用。

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