超音波断層法による総頸動脈壁厚と脈圧との関係 Pulse Pressure and Common Carotid Arterial Wall Thickness Assessed by Ultrasonography

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平成7年9月から平成11年8月までの4年間の一連の入院患者における降圧剤および高脂血症治療剤非服用者で, 脂質・糖代謝, 血圧に影響を及ぼしうる栄養障害や心・腎機能障害のない者を対象として, 既知の動脈硬化危険因子に加えて平均血圧 (2/3拡張期血圧+1/3収縮期血圧) と脈圧 (収縮期血圧-拡張期血圧) との2つを加味し, 総頸動脈硬化性病変との関係を検討した. 総頸動脈硬化性病変については, 日立EUB-565の超音波断層装置と7.5MHzリニア型探触子を用いて総頸動脈の内膜中膜複合体の厚さ (以下頸動脈壁厚) を計測した. 高血圧群 (平均血圧≧107mmHg) は53人と少なかったことより, 以下の検討では, 正常血圧群 (平均血圧<107mmHg) 358人 (年齢: 67.8±15.1歳), 男性182人 (年齢: 65.2±15.9歳), 女性176人 (年齢: 70.4±13.7歳) のみを対象として行った. 脈圧3分位, すなわち50mmHg以下 (PP1), 51~65mmHg (PP2), 66mmHg以上 (PP3) 別に検討すると, 脈圧が大きい群ほど年齢は有意に高く (p: 0.0011), 女性の頻度が多かったが (p=0.0315), BMI, Brinkman index, 脂質代謝, 尿酸, 糖代謝といった背景因子には差異はなかった. 平均血圧と脈圧との関係では男女ともに正の相関を認め, 各々r=0.31 (p<0.001) であった. 脈圧と血圧パラメーターとの関係については, 脈圧が大きい群ほど収縮期血圧, 平均血圧, 脈圧は有意に大きかったが (各々p<0.001), 拡張期血圧では逆に小さかった (p=0.0275). 脈圧と頸動脈壁厚との関係では, 男女ともに脈圧が大きい群ほど頸動脈壁厚は有意に大きかった (各々p<0.001, p=0.0042). 頸動脈壁厚 (1.0mm以上を肥厚と定義) を目的変数とし, 平均血圧と脈圧を含めた各種危険因子を説明変数としたロジスティック回帰分析では, 男性では脈圧とLDL-C, 女性では年齢, Brinkman index, T-Chol, HDL-C, 全体では男性, 年齢, Brinkman index, 脈圧, TG, LDL-Cが有意な独立危険因子であった. これらより, 脈圧も頸動脈壁厚の危険因子として重要であると考えられる.

This study was conducted on a total of 358 normotensive (mean blood pressure<107mmHg) inpatients (182 men and 176 women, mean age: 67.8years) who had no cardiorenal or nutrition disorders that would affect blood pressure, lipid and glucose metabolism and who had not been given depressors or antilipidemic agents during the four years from September 1995 to August 1999. In addition to the known risk factors for atherosclerosis, the effects of pulse pressure and mean blood pressure on sclerotic changes of the carotid arteries were examined. These sclerotic changes were assessed by measuring the thickness of the combined intima-media of the common carotid artery (carotid arterial wall thickness) by ultrasonography (Hitachi EUB-565) and linear probe (7.5MHz). When the patients were divided into three groups based on pulse pressure (PP1, lower than 51mmHg; PP2, 51-65mmHg; PP3, higher than 65mmHg), the age of the group with higher pulse pressure was significantly higher (p=0.0011), women more (p=0.0315). However there were no differences in background factors such as body mass index, Brinkman index, lipid metabolism, uric acid, and glucose metabolism. There was observed a positive correlation between the mean blood pressure and the pulse pressure for both men and women (r=0.31, p<0.001, respectively). As for the relation between the pulse pressures and the blood pressure parameters, the systolic blood pressure, pulse pressure and the mean blood pressure were significantly higher in the group with higher pulse pressure (p<0.001, respectively), but the diastolic blood pressure was significantly lower (p=0.0275). As for the relation between the pulse pressure and the carotid wall thickness, the groups of both men and women with higher pulse pressures had significantly greater cartoid arterial wall thickness (p<0.001, p=0.0042, respectively). Logistic regression analysis of the carotid arterial wall thickness (defined as hypertrophic if greater than 1.0mm) as the object variable and various risk factors including pulse pressure as the explanatory variables revealed that pulse pressure and LDL-C were significant independent contributing factors for men. The age, Brinkman index, T-Chol and HDL-C were significant independent contributing factors for women. For all subjects, men, the age, Brinkman index, pulse pressure, TG and LDL-C were significant independent contributing factors. These facts suggest that pulse pressure is an important risk factor for thickening of the carotid arterial wall.

収録刊行物

  • 日本老年医学会雑誌

    日本老年医学会雑誌 37(6), 479-485, 2000-06-25

    The Japan Geriatrics Society

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各種コード

  • NII論文ID(NAID)
    10008487746
  • NII書誌ID(NCID)
    AN00199010
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    03009173
  • NDL 記事登録ID
    5439795
  • NDL 雑誌分類
    ZS21(科学技術--医学--内科学)
  • NDL 請求記号
    Z19-25
  • データ提供元
    CJP書誌  NDL  J-STAGE 
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