Establishment and preliminary verification of threshold model for assessing carotid stiffness quantified with real-time ultrafast pulse wave velocity in healthy adults
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摘要: 目的:利用超极速脉搏波(ufPWV)技术定量评估健康成人颈动脉弹性,建立ufPWV理想阈值模型并对其进行初步验证。方法:选择2018年1月—2020年8月在江苏省中医院超声医学科行ufPWV检测的健康成人100例为建模组,另招募534例患者为验证组。建模组采用多元线性回归分析,计算收缩末期脉搏波速度(PWV-ES)与各动脉粥样硬化危险因素的模型公式;根据此公式,将验证组再分为弹性正常组(≤理想PWV-ES值)及弹性增高组(>理想PWV-ES值),并以年龄及颈动脉内中膜厚度(cIMT)作为参考体系对该模型进行初步双重验证。结果:建模组相关性分析显示,cIMT、收缩起始脉搏波波速(PWV-BS)及PWV-ES与年龄均有显著相关性;但PWV-ES(r=0.790,P<0.001)与年龄的相关性显著优于cIMT(r=0.676,P<0.001)及PWV-BS(r=0.393,P<0.001)。建模组PWV-ES的多元线性回归分析得出模型公式为:PWV-ES(m/s)=0.101×年龄(岁)+0.467×总胆固醇(mmol/L)+0.651×性别(男=1,女=0)+0.413。验证组PWV-ES与年龄亦具有良好相关性(r=0.563,P<0.001)。进一步验证显示,在不同年龄段中,弹性增高组比弹性正常组的PWV-ES均有较显著的提升,二者之间可见较清晰的分界;PWV-ES增高人群随年龄不断增高,其比例也随之逐步增高。此外,以cIMT作参考体系的验证显示,ROC分析的曲线下面积为0.744(95%CI 0.695~0.794,P<0.001),初步证实该模型公式对于粥样硬化相关动脉弹性衰退具有良好的诊断效能和潜在的应用价值。结论:本研究为ufPWV技术提供了理想值预测模型公式,对该技术及相关动脉弹性个体化阈值在临床的应用,进行了初步的尝试及验证。Abstract: Objective: We used ultrafast pulse wave velocity(ufPWV) technology to quantitatively evaluate carotid artery elasticity in healthy adults, then established ufPWV ideal threshold model and conducted preliminary verification.Methods: The 100 healthy adults tested by ufPWV were selected as the modeling group, and another 534 patients were recruited as the verification group. In the modeling group, multiple linear regression analysis was used to calculate the model formulas of pulse wave velocide-end of systole(PWV-ES) and the risk factors of each atherosclerosis. According to this formula, the verification group was divided into the normal elastic group(≤ ideal PWV-ES value) and the group with increased elasticity(>ideal PWV-ES value), and the model featured by its various features was adopted as the reference system to conduct preliminary double verification.Results: Correlation analysis of the modeling group showed that cIMT, pulse wave velocity-beginning of systole(PWV-BS) and PWV-ES were significantly correlated with age. However, the correlation between age and PWV-ES(r=0.790, P<0.001) was significantly better than that between cIMT(r=0.676, P<0.001) and PWV-BS(r=0.393, P<0.001). Multiple linear regression analysis of PWV-ES in the modeling group obtained the model formula as follows: PWV-ES(m/s)=0.101×age(age)+0.467× total cholesterol(mmol/L)+0.651×gender(male=1, female=0)+0.413. There was also a good correlation between PWV-ES and age in the verification group(r=0.563, P<0.001). Further verification showed that in different age groups, PWV-ES in the increased elasticity group were significantly improved compared with those in the normal elasticity group, with a clear boundary between them. In addition, the validation with cIMT as the reference system showed that the area under the curve of ROC analysis was 0.744(95%CI 0.695-0.794, P<0.001).Conclusion: This study provides the ideal value prediction model formula for ufPWV technology.
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