Evaluation of ultrafast pulse wave technique in subclinical atherosclerosis in SLE and its clinical correlates
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摘要:
目的 应用极速脉搏波技术评估不同活动度系统性红斑狼疮(SLE)患者的血管弹性并探究其相关危险因素。 方法 选取2020年10月—2024年4月就诊于蚌埠医科大学第一附属医院的116例SLE患者，根据SLE疾病活动性指数2000分为轻度活动组(57例)和中重度活动组(59例)，纳入45名健康成年人作为对照组。测量各组的颈动脉内中膜厚度(IMT)、收缩期起始时的脉搏波传导速度(PWV-BS)及收缩期末的脉搏波传导速度(PWV-ES)，比较3组颈动脉参数及临床资料，分析脉搏波传导速度(PWV)与各指标之间的相关性。 结果 3组间PWV-BS、PWV-ES比较，中重度活动组>轻度活动组>对照组(P＜0.05)。PWV-BS与颈总动脉IMT(r=0.315, P < 0.001)、收缩压(r=0.190, P=0.041)、舒张压(r=0.191, P=0.040)呈正相关关系，PWV-ES与颈动脉分叉处IMT(r=0.274, P=0.003)、颈总动脉IMT(r=0.361, P < 0.001)、舒张压(r=0.252, P=0.006)呈正相关关系。 结论 SLE患者的颈动脉弹性减低明显早于健康者，极速脉搏波可定量评估SLE患者颈动脉弹性，且不受限于时期，这为临床早期动脉硬化评估提供了客观依据。 Abstract:Objective To make an assessment of vascular elasticity in patients with systemic lupus erythematosus (SLE) at varying levels of disease activity using ultrafast pulse wave technique, and to investigate associated clinical risk factors. Methods A total of 116 SLE patients admitted to the First Affiliated Hospital of Bengbu Medical University from October 2020 to April 2024 were selected. Patients were divided into a mild activity group (n=57) and a moderate-to-severe activity group (n=59) according to SLE disease activity index 2000. Additionally, 45 healthy adults were included as the control group. Carotid intima-media thickness (IMT), pulse wave velocity at the beginning of systole (PWV-BS), and pulse wave velocity at the end of systole (PWV-ES) were measured in each group. Clinical data of each group were recorded and analyzed. Carotid artery parameters and clinical data of the three groups were compared to analyze the correlation between PWV parameters and various indicators. Results Both PWV-BS and PWV-ES showed significant differences among the three groups, following the pattern: moderate-to-severe activity group > light activity group > control group (P < 0.05). PWV-BS was positively correlated with common carotid artery IMT (r=0.315, P < 0.001), systolic blood pressure (r=0.190, P=0.041), and diastolic blood pressure (r=0.191, P=0.040). PWV-ES was positively correlated with carotid bifurcation IMT (r=0.274, P=0.003), common carotid artery IMT (r=0.361, P < 0.001), and diastolic blood pressure (r=0.252, P=0.006). Conclusion The reduction in carotid artery elasticity in SLE patients occurs significantly earlier compared to healthy individuals. Ultrafast pulse wave is valuable, time-independent, and objective tool for quantitative assessing early vascular changes in patients with SLE, thus facilitating the early detection and clinical management of atherosclerosis. -
图 1 SLE组与健康对照组ufPWV技术检查结果
注：A为对照组，PWV-BS为3.38 m/s，PWV-ES为5.33 m/s；B为轻度活动组，PWV-BS为4.67 m/s，PWV-ES为7.61 m/s；C为中重度活动组，PWV-BS为5.25 m/s，PWV-ES为10.26 m/s。
Figure 1. Results of ufPWV technique examination in the SLE group and healthy control group
表 1 3组研究对象性别和年龄比较
Table 1. Comparison of gender and age among three groups
组别 例数 性别[例(%)] 年龄[M(P25, P75), 岁] 男性 女性 轻度活动组 57 7(12.28) 50(87.72) 42.00(34.00, 50.00) 中重度活动组 59 3(5.08) 56(94.92) 39.00(30.50, 50.50) 对照组 45 5(11.11) 40(88.89) 40.00(34.00, 46.00) 统计量 2.015a 1.261b P值 0.365 0.532 注：a为χ2值，b为H值。 
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表 2 3组研究对象临床资料比较[M(P25, P75)]
Table 2. Comparison of clinical data among three groups[M(P25, P75)]
组别 例数 SBP(mmHg) DBP(mmHg) TC(mmol/L) TG(mmol/L) HDL(mmol/L) LDL(mmol/L) 轻度活动组 57 123.00(115.00, 133.00) 79.00(72.00, 88.00) 4.27(3.64, 4.82) 1.37(1.04, 2.13) 1.22(0.97, 1.44) 2.34(1.98, 2.66) 中重度活动组 59 129.00(117.50, 145.50)a 82.00(73.00, 97.00)a 4.38(3.33, 5.40) 1.31(0.81, 1.90) 1.30(1.01, 1.56) 2.52(1.98, 3.17) 对照组 45 118.00(112.00, 125.00) 76.00(72.00, 81.00) 4.11(3.73, 4.50) 1.32(1.06, 1.80) 1.21(0.97, 1.48) 2.29(1.89, 2.86) 统计量 10.471b 7.412b 2.879b 0.933b 1.049b 3.608b P值 0.005 0.025 0.237 0.627 0.592 0.165 组别 例数 APO(a)(g/L) APO(b)(g/L) LP(a)(mg/L) CRP(mg/L) ESR(mm/h) 病程(月) 轻度活动组 57 1.06(0.87, 1.23) 0.79(0.67, 0.90) 155.00(63.00, 280.00)a 4.60(1.91, 7.70)a 34.00(28.00, 40.00) 60.00(12.00, 132.00) 中重度活动组 59 1.17(0.86, 1.38) 0.85(0.69, 0.96) 151.00(102.00, 285.50)a 6.20(1.95, 23.00)ac 44.00(38.00, 50.00)c 96.00(12.00, 144.00) 对照组 45 1.10(0.90, 1.28) 0.76(0.68, 0.96) 88.00(56.00, 220.00) 0.80(0.60, 2.00) 统计量 1.305b 1.283b 6.400b 42.146b -4.562d 0.982d P值 0.521 0.526 0.041 < 0.001 < 0.001 0.326 注：与对照组比较，aP < 0.05；与轻度组比较，cP < 0.05；b为H值，d为Z值。1 mmHg=0.133 kPa。
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表 3 SLE组左、右侧颈动脉IMT和PWV比较[M(P25, P75)]
Table 3. Comparison of left and right carotid IMT and PWV in the SLE group[M(P25, P75)]
组别 例数 分叉处IMT(mm) 颈总动脉IMT(mm) PWV-BS(m/s) PWV-ES(m/s) 右侧颈动脉 116 0.78(0.70, 0.81) 0.71(0.64, 0.77) 5.48(4.78, 6.38) 7.13(6.26, 8.17) 左侧颈动脉 116 0.78(0.71, 0.82) 0.73(0.64, 0.78) 5.47(4.91, 6.02) 7.47(6.77, 8.46) Z值 -0.361 -1.800 -0.180 -1.785 P值 0.718 0.072 0.857 0.074
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表 4 对照组左、右侧颈动脉IMT、PWV比较[M(P25, P75)]
Table 4. Comparison of left and right carotid IMT and PWV in the control group[M(P25, P75)]
组别 例数 分叉处IMT(mm) 颈总动脉IMT(mm) PWV-BS(m/s) PWV-ES(m/s) 右侧颈动脉 45 0.71(0.68, 0.75) 0.66(0.60, 0.68) 4.63(4.24, 4.88) 5.74(5.43, 6.34) 左侧颈动脉 45 0.70(0.70, 0.73) 0.66(0.60, 0.70) 4.46(4.10, 4.86) 5.66(5.40, 5.89) Z值 -0.886 -1.595 -0.728 -1.506 P值 0.375 0.111 0.467 0.132
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表 5 3组研究对象超声参数比较[M(P25, P75)]
Table 5. Comparison of ultrasonic parameters among three groups[M(P25, P75)]
组别 例数 分叉处IMT(mm) 颈总动脉IMT(mm) PWV-BS(m/s) PWV-ES(m/s) 对照组 45 0.71(0.69, 0.74) 0.65(0.60, 0.69) 4.48(4.02, 4.96) 5.75(5.34, 6.29) 轻度活动组 57 0.75(0.71, 0.80)a 0.69(0.63, 0.74)a 5.22(4.75, 5.68)a 6.85(6.46, 7.66)a 中重度活动组 59 0.79(0.73, 0.85)a 0.71(0.68, 0.76)ab 6.00(5.37, 6.55)ab 7.91(7.28, 8.73)ab H值 22.400 37.215 73.939 81.189 P值 < 0.001 < 0.001 < 0.001 < 0.001 注：与对照组比较，aP < 0.05；与轻度组比较，bP < 0.05。
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