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中华危重症医学杂志(电子版) ›› 2021, Vol. 14 ›› Issue (03) : 192 -198. doi: 10.3877/cma.j.issn.1674-6880.2021.03.004

论著

联合应用二维斑点追踪和血管回声追踪技术预测高血压并发急性主动脉综合征发生的价值
冀加美1, 吴娟1, 顾文慧1, 裴勇凯1, 王艳丽1, 龚敏1, 武俊1,†()   
  1. 1. 116027　辽宁大连，大连医科大学附属第二医院超声科
  • 收稿日期:2020-12-06 出版日期:2021-06-30
  • 通信作者: 武俊
  • 基金资助:
    辽宁省自然科学基金面上项目(2019-MS-093)

Value of two-dimensional speckle tracking echocardiography and vascular echo tracking techniques in predicting the occurrence of hypertension complicated with acute aortic syndrome

Jiamei Ji1, Juan Wu1, Wenhui Gu1, Yongkai Pei1, Yanli Wang1, Min Gong1, Jun Wu1,†()   

  1. 1. Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian 116027, China
  • Received:2020-12-06 Published:2021-06-30
  • Corresponding author: Jun Wu
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引用本文：

冀加美, 吴娟, 顾文慧, 裴勇凯, 王艳丽, 龚敏, 武俊. 联合应用二维斑点追踪和血管回声追踪技术预测高血压并发急性主动脉综合征发生的价值[J/OL]. 中华危重症医学杂志(电子版), 2021, 14(03): 192-198.

Jiamei Ji, Juan Wu, Wenhui Gu, Yongkai Pei, Yanli Wang, Min Gong, Jun Wu. Value of two-dimensional speckle tracking echocardiography and vascular echo tracking techniques in predicting the occurrence of hypertension complicated with acute aortic syndrome[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(03): 192-198.

目的

探讨联合应用二维斑点追踪和血管回声追踪技术在预测高血压并发急性主动脉综合征（AAS）发生中的价值。

方法

将2019年2月至2020年10月于大连医科大学附属第二医院进行诊治的50例高血压并发AAS患者纳入AAS组，另选取单纯性高血压患者50例作为HP组、健康志愿者50例作为对照组。比较3组患者的一般资料、升主动脉内径、升主动脉前壁纵向应变值（AW-LS）、升主动脉后壁纵向应变值（PW-LS）、颈总动脉收缩期最大内径（Dmax）及舒张期最小内径（Dmin）、颈总动脉内-中膜厚度（IMT）、颈总动脉僵硬度指数（β）及单点脉搏波传导速度（PWV β）。将体表面积、脉压差、升主动脉内径、AW-LS、PW-LS、Dmax、Dmin、IMT、β、PWV β纳入多因素Logistic回归分析，分析高血压并发AAS的独立危险因素；绘制受试者工作特征（ROC）曲线，并采用Z检验比较其曲线下面积（AUC）。

结果

对照组、HP组及AAS组患者体表面积[（1.76 ± 0.11）、（1.80 ± 0.18）、（1.85 ± 0.19）m2]、脉压差[（41 ± 8）、（61 ± 14）、（71 ± 16）mmHg]、升主动脉内径[（30.5 ± 3.0）、（35.1 ± 5.8）、（44.7 ± 7.8）mm]、AW-LS [（30 ± 5）%、（26 ± 8）%、（17 ± 5）%]、PW-LS [（32 ± 7）%、（31 ± 9）%、（22 ± 5）%]、Dmax [（7.4 ± 1.5）、（7.8 ± 1.3）、（8.7 ± 0.9）mm]、Dmin [（6.8 ± 1.0）、（7.4 ± 1.2）、（8.2 ± 0.9）mm]、IMT [（0.68 ± 0.26）、（1.25 ± 0.50）、（1.46 ± 0.50）mm]、β [（7.6 ± 1.7）、（10.0 ± 1.9）、（11.9 ± 3.5）]、PWV β [（6.5 ± 1.6）、（9.0 ± 1.5）、（10.0 ± 3.3）m / s]比较，差异均有统计学意义（F = 3.463、65.144、75.934、59.179、27.593、12.917、22.925、43.132、37.477、31.120，P均< 0.05）。多因素Logistic回归分析，结果显示，升主动脉内径[比值比（OR）= 1.247，95%置信区间（CI）（1.033，1.505），P = 0.021]和β [OR = 1.811，95%CI（1.180，2.778），P = 0.007]为高血压患者并发AAS的独立危险因素，而AW-LS [OR = 0.668，95%CI（0.526，0.848），P = 0.001]和PW-LS [OR = 0.661，95%CI（0.510，0.856），P = 0.002]是其保护因素。ROC曲线分析结果显示，升主动脉内径[AUC = 0.913，95%CI（0.867，0.960），P < 0.001]、AW-LS [AUC = 0.915，95%CI（0.869，0.961），P < 0.001]、PW-LS [AUC = 0.752，95%CI（0.674，0.830），P < 0.001]、β [AUC = 0.781，95%CI（0.699，0.862），P < 0.001]及四项联合[AUC = 0.983，95%CI（0.968，0.998），P < 0.001]均对高血压患者并发AAS具有预测价值，且四项联合的AUC均明显高于升主动脉内径（Z = 3.158，P = 0.002）、AW-LS（Z = 3.216，P = 0.001）、PW-LS（Z = 6.119，P < 0.001）和β（Z = 4.981，P < 0.001）。

结论

升主动脉内径、AW-LS、PW-LS和β是AAS发生的独立预测因子，四项指标联合时可提高其预测效能。

关键词: 急性主动脉综合征, 高血压, 二维斑点追踪, 回声追踪
Objective

To evaluate the value of two-dimensional speckle tracking echocardiography combining vascular echo tracking techniques in predicting the occurrence of hypertension complicated with acute aortic syndrome (AAS).

Methods

Fifty hypertensive patients complicated with AAS in the Second Hospital of Dalian Medical University from February 2019 to October 2020 were included into the AAS group. Fifty hypertensive patients without AAS were enrolled as the HP group and fifty healthy volunteers as the control group. The general indicators, ascending aortic diameter, ascending aortic anterior wall-longitudinal strain (AW-LS), ascending aortic posterior wall-longitudinal strain (PW-LS), common carotid artery systolic maximum diameter (Dmax), common carotid artery systolic minimum diameter (Dmin), common carotid artery intima-media thickness (IMT), common carotid artery stiffness index (β) and single-point pulsed wave velocity (PWV β) were compared among these three groups. The body surface area, pulse pressure, ascending aortic diameter, AW-LS, PW-LS, Dmax, Dmin, IMT, β and PWV β were included in multivariate Logistic regression analysis and the independent risk factors of hypertension complicated with AAS were analyzed. A receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was compared by the Z-test.

Results

The body surface area [(1.76 ± 0.11), (1.80 ± 0.18), (1.85 ± 0.19) m2], pulse pressure [(41 ± 8), (61 ± 14), (71 ± 16) mmHg], ascending aortic diameter [(30.5 ± 3.0), (35.1 ± 5.8), (44.7 ± 7.8) mm], AW-LS [(30 ± 5)%, (26 ± 8)%, (17 ± 5)%], PW-LS [(32 ± 7)%, (31 ± 9)%, (22 ± 5)%], Dmax [(7.4 ± 1.5), (7.8 ± 1.3), (8.7 ± 0.9) mm], Dmin [(6.8 ± 1.0), (7.4 ± 1.2), (8.2 ± 0.9) mm], IMT [(0.68 ± 0.26), (1.25 ± 0.50), (1.46 ± 0.50) mm], β [(7.6 ± 1.7), (10.0 ± 1.9), (11.9 ± 3.5)], PWV β [(6.5 ± 1.6), (9.0 ± 1.5), (10.0 ± 3.3) m / s] in the control group, HP group and AAS group all showed significant differences (F = 3.463, 65.144, 75.934, 59.179, 27.593, 12.917, 22.925, 43.132, 37.477, 31.120; all P < 0.05). Multivariate Logistic regression analysis showed that the ascending aortic diameter [odds ratio (OR) = 1.247, 95% confidence interval (CI) (1.033, 1.505), P = 0.021] and β [OR = 1.811, 95%CI (1.180, 2.778), P = 0.007] were independent risk factors for hypertensive patients complicated with AAS, while the AW-LS [OR = 0.668, 95%CI (0.526, 0.848), P = 0.001] and PW-LS [OR = 0.661, 95%CI (0.510, 0.856), P = 0.002] were protective factors. The ROC curve showed that the ascending aortic diameter [AUC = 0.913, 95%CI (0.867, 0.960), P < 0.001], AW-LS [AUC = 0.915, 95%CI (0.869, 0.961), P < 0.001], PW-LS [AUC = 0.752, 95%CI (0.674, 0.830), P < 0.001], β [AUC = 0.781, 95%CI (0.699, 0.862), P < 0.001] and the four joint items [AUC = 0.983, 95%CI (0.968, 0.998), P < 0.001] all have predictive value for hypertensive patients complicated with AAS. Moreover, the AUC of four joint items was significantly higher than that of the ascending aortic diameter (Z = 3.158, P = 0.002), AW-LS (Z = 3.216, P = 0.001), PW-LS (Z = 6.119, P < 0.001) and β (Z = 4.981, P < 0.001).

Conclusions

The ascending aortic diameter, AW-LS, PW-LS and β are independent predictors for the occurrence of AAS in hypertensive patients. The predictive potential of AAS increases significantly when these four parameters are combined.

Key words: Acute aortic syndrome, Hypertension, Two-dimensional speckle tracking echocardiography, Echo-tracking
表1 3组患者一般资料比较（ ± s）
组别 例数 年龄（岁） 性别（例，男/女） 体表面积（m2） 脉压差（mmHg）
对照组 50 55 ± 5 28 / 22 1.76 ± 0.11 41 ± 8
HP组 50 59 ± 10 33 / 17 1.80 ± 0.18 61 ± 14a
AAS组 50 58 ± 12 36 / 14 1.85 ± 0.19a 71 ± 16ab
F / χ2值   2.078 2.859 3.463 65.144
P值   0.129 0.239 0.034 < 0.001
表2 3组患者升主动脉2D-STE及颈总动脉ET各指标比较（ ± s）
组别 例数 升主动脉内径（mm） AW-LS（%） PW-LS（%） Dmax（mm） Dmin（mm） IMT（mm） β PWV β（m / s）
对照组 50 30.5 ± 3.0 30 ± 5 32 ± 7 7.4 ± 1.5 6.8 ± 1.0 0.68 ± 0.26 7.6 ± 1.7 6.5 ± 1.6
HP组 50 35.1 ± 5.8a 26 ± 8a 31 ± 9 7.8 ± 1.3 7.4 ± 1.2a 1.25 ± 0.50a 10.0 ± 1.9a 9.0 ± 1.5a
AAS组 50 44.7 ± 7.8ab 17 ± 5ab 22 ± 5ab 8.7 ± 0.9ab 8.2 ± 0.9ab 1.46 ± 0.50ab 11.9 ± 3.5ab 10.0 ± 3.3ab
F值   75.934 59.179 27.593 12.917 22.925 43.132 37.477 31.120
P值   < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
表3 多因素Logistic回归分析高血压患者并发AAS的影响因素
影响因素 回归系数 标准误 Wald值 P值 OR值 95%CI
体表面积（m2） 1.211 3.104 0.152 0.696 3.358 0.008 ~ 1 471.828
脉压差（mmHg） 0.028 0.035 0.621 0.431 1.028 0.960 ~ 1.102
升主动脉内径（mm） 0.221 0.096 5.301 0.021 1.247 1.033 ~ 1.505
AW-LS（%） -0.404 0.122 10.972 0.001 0.668 0.526 ~ 0.848
PW-LS（%） -0.415 0.132 9.824 0.002 0.661 0.510 ~ 0.856
Dmax（mm） -5.532 4.006 1.906 0.167 0.004 0.000 ~ 10.182
Dmin（mm） 6.855 4.412 2.415 0.120 949.003 0.167 ~ 5 400 228.308
IMT（mm） 0.564 1.010 0.312 0.576 1.758 0.243 ~ 12.729
β 0.594 0.218 7.384 0.007 1.811 1.180 ~ 2.778
PWV β（m / s） 0.260 0.229 1.294 0.255 1.297 0.829 ~ 2.030
表4 ROC曲线分析升主动脉内径、AW-LS、PW-LS、β及四项联合对高血压患者并发AAS的预测价值
影响因素 AUC 标准误 P值 95%CI 敏感度（%） 特异度（%）
升主动脉内径（mm） 0.913 0.024 < 0.001 0.867 ~ 0.960 96.0 84.0
AW-LS（%） 0.915 0.023 < 0.001 0.869 ~ 0.961 90.0 85.0
PW-LS（%） 0.752 0.040 < 0.001 0.674 ~ 0.830 70.0 74.0
β 0.781 0.042 < 0.001 0.699 ~ 0.862 54.0 91.0
四项联合 0.983 0.008 < 0.001 0.968 ~ 0.998 96.0 90.0
图1 各指标诊断高血压并发AAS的ROC曲线分析
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