中心动脉压与血管功能课件

,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,中心动脉压与血管功能,中心动脉压与血管功能,1,、中心动脉压机制与方法评价,2,、中心动脉压的意义,3,、血管功能指标和意义,4,、血管功能指标临床研究,内 容,1、中心动脉压机制与方法评价2、中心动脉,1,、中心动脉压机制与方法评价,2,、中心动脉压的意义,3,、血管功能指标和意义,4,、血管功能指标临床研究,内 容,1、中心动脉压机制与方法评价2、中心动脉压,动脉压,相关因素,心搏量,末梢阻力,血管壁硬度,反射波,动脉压相关因素,中心动脉压,主动脉顺应性（大血管硬度）,反射波,时间,幅度,中心动脉压,London and Guerin. Am Heart J 1999;138:220-224,Normal,Decreased aortic compliance,Systole,Diastole,40%,60%,60%,50%,50%,50%,Aortic compliance and pulse pressure,Systole,Diastole,Windkessel function,London and Guerin. Am Heart J,大动脉顺应性降低，弹性降低，收缩压力在动脉内不能得到缓冲，使收缩压升高。,舒张期大血管弹性回缩减低，使舒张压降低。,结果：,脉压增大,主动脉顺应性下降,大动脉顺应性降低，弹性降低，收缩压力在动脉内不能得到缓冲，使,Augmentation,and,reflection wave,Incident wave,Reflection wave,McDonalds fourth edition,Augmentation and reflection wa,Systolic BP,Augmentation,Index,Diastolic BP,Arrival of reflection wave,Arterial pressure waveform and reflection wave,Systolic BPAugmentation Diast,反射波机制对中心动脉压的影响,脉搏波传导速度,(PWV) -,反射波速度,阻力微、小动脉,反射位点,动脉弹性,-,反射波幅度,心率,-,反射波在收缩期叠加的幅度,反射波机制对中心动脉压的影响 脉搏波传导速度(PWV) -,AI,与主动脉压、脉压的测量,AI与主动脉压、脉压的测量,中心动脉压与血管功能课件,中心动脉压与血管功能课件,1,、中心动脉压机制与方法评价,2,、中心动脉压的意义,3,、血管功能指标和意义,4,、血管功能指标临床研究,内 容,1、中心动脉压机制与方法评价2、中心动脉压,Attenuation of peripheral augmentation effect by arterial stiffness,Peripheral BP and central BP,Nichols WW et al. 1993,68 years old,24 years old,50,100,150,(mmHg),50,100,150,(mmHg),Attenuation of peripheral augm,0,20,40,60,80,100,120,140,160,-49,50-59,60-69,70-,31,49,32,31,(,mmHg),Reflection component,Age,Estimated aortic blood pressure,Kohara K et al.,J Am Geriatr Soc, 1999,Incident component,Aortic diastolic BP,Age and central blood pressure,Radial BP was matched as 150 mmHg in all age groups,020406080100120140160-4950-596,Systolic hypertension,Wide pulse pressure,Central hypertension,augmentation by,reflection pressure wave,Arterial stiffness,Reduced compliance,Impaired Windkessel function,Systolic hypertensionCentral h,The Great Hemodynamic Divide,Mean Pressure,Anatomy Heart, small arteries Aorta,Physiology,Cardiac output,Stiffiness,Peripheral resistance,BP, SBP , DBP, SBP DBP,Event Risk Risk,Pulse Pressure,The Great Hemodynamic DivideMe,The Strong Heart Study,Central Blood Pressure Better predicts Cardiovascular Events than Does Peripheral Blood Pressure,2662 patients, 63yrs, follow-up 3.4y,Roman MJ, et al. AHA Sept. 2005,The Strong Heart StudyCentral,The Strong Heart Study: Cox regression analyses,(,校正年龄、性别、体重指数、吸烟、,LDL-C,、,DM,),主动脉,SBP,和,PP,与,CVD,发生率独立相关，,RR/10mmHg,分别为,1.07,与,1.10, p,分别为,0.043,与,0.009,。,进一步校正颈动脉粥样硬化病变，主动脉,PP,仍然与,CVD,显著独立相关。,The Strong Heart Study: Cox re,Reflection of pressure wave as risk factor,ESRD patients,Blacher et al. Circulation, 1999,1.0,0.75,0.50,0.25,0,0,35,70,105,140,Survival rate for cardiovascular death,Time (month),PWV9.4m/s,9.4PWV12.0m/s,12.0m/s PWV,1.0,0.75,0.50,0.25,0,0,35,70,105,140,Even free rate for cardiovascular accidents,Time (month),Augmentation index 1,群,Augmentation index 2,群,Augmentation index 3,群,Augmentation index 4,群,London GM et al. Hypertension, 2001,Reflection of pressure wave as,中心动脉压和脉压升高对,心血管系统影响,左室后负荷增加，左室重构,冠状动脉灌注下降，储备功能下降，,心肌缺血,内皮损伤和功能紊乱，动脉硬化性疾病,进展,中心动脉压和脉压升高对 左室后负荷增加，左室重构,中心动脉压与血管功能课件,中心动脉压与血管功能课件,中心动脉压与血管功能课件,Circulation 2004;109:184-189,NO lesions,12,11,10,9,8,7,6,5,4,3,Augmented pressure,mmHg,One,vessel,Two,vessels,Three vessels,AI,and coronary heart disease,Association between aortic AI and coronary arteriogram,Circulation 2004;109:184-189NO,160,140,120,100,80,60,Smulyan H et al. Ann Intern Med 2000,1601401201008060Smulyan H et a,160,120,80,160,120,160,120,80,Adolescence,Middle age,Elderly,500,500,500,0,0,0,0,150,0,150,0,150,Ascending Aortic BP (,mmHg),Ascending Aortic blood flow (,ml/s),Coronary blood flow (ml/min),80,McDonalds fourth edition,1601208016012016012080Adolesce,Blood pressure,(mmHg),吸烟对中心动脉压和周围动脉压的影响,50,60,70,80,90,100,110,120,130,140,-8,-7,-6,-5,-4,-3,-2,-1,0,1,2,Aortic AI,(%),*,Brachial BP,Aortic BP,*,*,p0.05,Non-smoker (n=116),Smokers (n=41),Hypertension. 2003;41:183-187,Blood pressure (mmHg)吸烟对中心动脉压和,J Am Coll Cardiol 2002;39:1005,160,150,140,130,120,110,100,90,80,70,Control subjects,(n=68),Hyperlipidemia,(n=68),0.,0,1,*,Blood pressure (mmHg),Peripheral BP,Central BP,Hyperlipidemia and central BP,J Am Coll Cardiol 2002;39:1005,Hypertension 43:176181, 2004,Glucose intolerance and arterial stiffness,The Hoorn Study,1.2,1.0,0.8,0.6,243,129,256,60,55,50,45,40,120,74,125,34,33,32,31,30,261,170,188,Total arterial compliance,(SV/carotid PP, ml/mmHg),Transmission time from,carotid artery to femoral artery,(msec),Augmentation index,(%),*,*,*,*,Control,Impaired glucose tolerance,Type 2 DM,Hypertension 43:176181, 2004G,Change in HR,(bpm),-10,-8,-6,-4,-2,0,Change in AI,(%),-1.2,-1,-0.8,-0.6,-0.4,-0.2,0,Change in PWV,(m/sec),-5,-4,-3,-2,-1,0,1,2,3,4,Asmar RG, et al. Hypertension. 2001;38:922,*,*,MeanSD.,*p0.05, * p0.001 vs atenolol.,Effect of antihypertensive drugs on brachial BP and central BP,Diastolic BP on brachial artery was matched for 1 year,Perindopril / indapamide,(n=204),atenolol (n=202),Change in HR (bpm)-10-8-6-4-20,Am J Hypertens 17:118123, 2004,70,80,90,100,110,120,130,140,150,160,170,Placebo,*,*,*,*,*,*,*,*,*,*,*,*,Blood pressure (mmHg),peripheral,central,32 elderly hypertensive patients (age 65-80) were treated for 4 weeks each drugs in double blind and cross-over fashion.,Effect of antihypertensive drugs,double blind and cross-over study,ACE inhibitor,b-blocker,Ca channel,blocker,diuretics,Am J Hypertens 17:118123, 200,E,ffect of antihypertensive drugs on,AI and,central BP,AICentral BP,diuretics,b,-blocker,ACE inhibitor/ARB,Ca channel blocker,Effect of antihypertensive dru,CAF:,肱动脉和中心动脉,收缩压,肱动脉收缩压,平均差异,(AUC)=0.7mmHg,133.9,133.2,氨氯地平,阿替洛尔,P=.07,125.5,121.2,P.0001,0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6,AUC,115,140,135,130,125,120,mm Hg,中心动脉收缩压,平均差异,(AUC)=4.3mmHg,时间,(,年,),阿替洛尔,86 243 324 356 445 372 462 270 339 128 85 1031,氨氯地平,88 248 329 369 475 406 508 278 390 126 101 1042,CAF: 肱动脉和中心动脉收缩压肱动脉收缩压133.9氨氯,CAF:,血压对终点事件的影响（未校正的多因素分析）,X,2,P,值,HR,CI,肱动脉脉压的差值,21.0,0.0001,1.21,1.12-1.30,中心动脉脉压的差值,17.8,0.0001,1.20,1.11-1.30,中心动脉压,增强指数,7.10,0.008,1.22,1.06-1.40,P1,19.0,0.0001,1.37,1.20-1.54,X,2,P,值,HR,CI,中心动脉脉压,的差值,3.91,0.048,1.11,1.00-1.21,（经校正的多因素分析）,CAF: 血压对终点事件的影响（未校正的多因素分析）X2,GREAT DEBATES IN HYPERTENSION:2007ACC,Antihypertensive Therapy Should be Tailored to Measures of Arterial Stiffness,Still not enough data to make this assertion. However, there is need to develop such data.,GREAT DEBATES IN HYPERTENSION:,1,、中心动脉压机制与方法评价,2,、中心动脉压的意义,3,、血管功能指标和意义,4,、血管功能指标临床研究,内 容,1、中心动脉压机制与方法评价2、中心动脉,动脉血管功能改变,中、大动脉顺应性下降,舒缩功能下降,小动脉阻力增加,顺应性下降,储备能力下降,动脉血管痉挛,动脉血管功能改变中、大动脉顺应性下降,Methods for Detecting Vessel Disease,Pulse contour analysis (C1，C2),Pulse Wave Velocity (PWV),Aortic pressure augmentation (reflected waves), Pulse pressure,Flow-mediated vasodilation,Flow reserve,Biopsy,Urinary protein excretion,Methods for Detecting Vessel D,乙酰胆碱,试验,在基线期无严重的梗阻性缺损,给予乙酰胆碱后出现反常的血管收缩反应,乙酰胆碱试验在基线期无严重的梗阻性缺损给予乙酰胆碱后出现反常,血流介导的,血管,扩张,（,FMD）,测量,血流介导的血管扩张（FMD）测量,血管舒张,非内皮依赖性舒张功能,(,endothelium-independent,dilatation, EID),内皮依赖性舒张功能,(,endothelium-dependent,dilation, EDD),药物:,乙酰胆碱,生理性刺激:,反应性充血,FMD,硝普钠、,硝酸甘油等,内皮由来,NO,外源,NO,动脉血管舒张功能,血管舒张非内皮依赖性舒张功能 内皮依赖性舒张功能药物:生理性,Survival without ischemic heart disease in hypertensive,patients with MA or normoalbuminuria (MONICA study),0,1,2,3,4,5,6,7,8,9,10,years,(,Jensen et al: Hypertension, 2000),75,80,85,90,95,100,70,Proportion without ischemic heart disease (%),P30,mg/24h,30,mg/24h,Survival without ischemic hear,1,、中心动脉压机制与方法评价,2,、中心动脉压的意义,3,、血管功能指标和意义,4,、血管功能指标临床研究,我们的工作,内 容,1、中心动脉压机制与方法评价2、中心动脉,24小时动态血压与动脉内皮功能相关性的研究,“非杓型”原发性高血压患者靶器官的损伤远较 “杓型”患者严重，心脑血管事件的发生率更高。动脉内皮功能的变化？,原发性高血压患者46名，,“,杓型,”,31名，,“,非杓型,”,15名,测定,FMD(Flow mediated,-,dilation),24小时动态血压与动脉内皮功能相关性的研究 “非杓型”原发,0,2,4,6,8,10,12,“,非杓型,”,组,“,杓型,”,组,FMD（%,）,注：,“,杓型,”,和,“,非杓型,”,两组,FMD,比较，,p0.001,“,杓型,”,和,“,非杓型,”,两组,FMD,比较,024681012“非杓型”组“杓型”组FMD（%）注：“,FMD,与,24,hSBP,的相关性,r=-0.438,FMD,FMD与24hSBP的相关性r=-0.438FMD,FMD,与年龄的相关性,r=-0.409,FMD,FMD与年龄的相关性r=-0.409FMD,阿托伐他汀对血脂正常高血压患者血管内皮功能的影响,高血压病患者早期即有血管内皮功能失调。,他汀类药物对血脂正常高血压患者是否改善血管内皮功能？与剂量的关系？,阿托伐他汀对血脂正常高血压患者血管内皮功能的影响高血压病患,0,5,10,15,20,25,30,ator10mg,ator20mg,normal,FMD/EID(%),0周,FMD,4周后,FMD,0周,EID,4周后,EID,阿托伐他汀对血脂正常高血压,患者,FMD/ EID,影响,p0.05,p0.01,051015202530ator10mgator20mgno,结 论,高血压病患者内皮功能失调表现为以内皮依赖性血管舒张反应减弱为特征。,阿托伐他汀能改善血脂正常高血压患者血管内皮功能，可能具有剂量依赖性。,结 论高血压病患者内皮功能失调表现为以内皮依赖性血管,小 结,中心动脉压与脉压相关密切；与心血管事件相关性好；不同降压药对周围血压和中心动脉压降低不同，对评价不同降压药物作用有一定意义。,动脉功能评价方法多，不同侧面反映血管功能。有一定临床应用价值。,小 结中心动脉压与脉压相关密切；与心血管事件相关性好,谢 谢,谢 谢,血管的重要性,VHP,概念,V,ascular disease,H,ypertension,P,revention,将血管疾病,(,Vascular disease)、,高血压,(,Hypertension),和预防,(,Prevention),三者,作为一个整体来对待,血管的重要性VHP概念Vascular disease,讨论,高血压病患者表现为以内皮依赖性血管舒张反应减弱为特征的内皮功能失调,阿托伐他汀对内皮的保护功能非常明显，而且发生的非常早，独立于患者的脂质水平而存在，且可能剂量越大，患者的获益越大,讨论高血压病患者表现为以内皮依赖性血管舒张反应减弱为特征,中心动脉压与血管功能课件,结 论,“非杓型”原发性高血压患者较“杓型”的动脉,内皮功能损伤重;,年龄、血清总胆固醇、 24小时平均收缩压是,影响动脉内皮功能变化的独立危险因素。,结 论 “非杓型”原发性高血压患者较“杓型”的动脉,Center for Research Translation,RCE,University,NIH, Military,D.H.S,WHO,Foreign,Assess,Grants,Contracts,Corporate,Private,VC,$,Business,Products Services R.O.I.,Jobs Technology Base,Contracts,Meet National Needs,Newco,Joint Ventures,Newco,Partnerships,Leads,Leads,Funds,Funds,Seek,Center for Research Translatio,Example: UTMB, AptaMed, Ciphergen, DowPharma and GE Healthcare,Discovery,“,Concept”,IP,Thioaptamers,In biodefense,Development,Pre-Clinical,Manufacture,“,Confirm”,Plan,License,AptaMed,GLP studies,Method Dev.,Diagnostics,Therapeutics,Make cGMP,Purify,Package,Regulatory,IND,test,NationalStockpile,UTMB Research Team,CTD/ORT,UTMB, AptaMed, Ciphergen, GE Healthcare,Government (DARPA/NIH),$,Example: UTMB, AptaMed, Cipher,Partnership: UTMB, AptaMed, and Ciphergen,Joint $6.3M NIAID Biodefense,Proteomics Collaboratory funding,Start-up AptaMed in Galveston,Incubator,New Ciphergen Diagnostics Division,in Austin to serve Region,New Ciphergen Satellite,Facility in Galveston Incubator,Partnership: UTMB, AptaMed, an,Conclusions,The bioterrorism threat is real,The time for action is now,Preparedness can serve as a deterrent,UTMB and the Gulf Coast are at the forefront of anti-bioterrorism and emerging diseases research,Vision: new biodefense industry is developing - we can lead this effort,Catalyst for biotechnology industry and jobs,ConclusionsThe bioterrorism th,谢谢！,谢谢！,