CN111000537B - Method for correcting influence of age, sex and blood pressure on pulse wave propagation speed - Google Patents
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Abstract
The invention discloses a method for correcting the influence of age, sex and blood pressure on the pulse wave propagation speed, which is characterized by comprising the following steps: the method comprises the following steps: establishing a function family between PWV and blood pressure of a population without arteriosclerotic lesions, and obtaining function parameters corresponding to each age and gender to form a parameter database; establishing a normalized model of the PWV under the fixed age, gender and blood pressure states; obtaining corrections for PWV versus age, gender and blood pressure; the measured PWV is corrected with correction amounts for age, gender and blood pressure. Through the steps, the method can eliminate the influence of physiological factors such as age, sex, instant blood pressure and the like on the PWV, better reflect the change of the PWV caused by pathological factors such as hypertension, hyperlipidemia, diabetes, arteriosclerosis, end-stage nephropathy and the like, and enable the evaluation of arteriosclerosis to be more accurate.
Description
Technical Field
The invention relates to a method for correcting the influence of age, sex and blood pressure on the pulse wave propagation speed.
Background
Arteriosclerosis is a non-inflammatory lesion of an artery, mainly manifested by thickening of a blood vessel wall, deterioration of elasticity, narrowing of a lumen and plaque formation, and is an important prediction index of myocardial infarction and cerebral infarction. Conventional methods for diagnosing arteriosclerosis are classified into an imaging examination and a Pulse Wave Velocity (PWV) examination. The imaging examination includes methods such as arteriography, CT, doppler ultrasound, etc., mainly presumes the condition of the whole arterial system by observing the pathological changes of part of arteries, and is not suitable for large-area screening such as health examination, etc. in view of the problems of radiation, traumatism, operation difficulty, etc. The Pulse Wave Velocity (PWV) method is the most commonly used method in arteriosclerosis screening, has the advantages of simple and noninvasive measuring method, capability of quantitatively detecting the systemic arteriosclerosis degree and wide acceptance as an independent predictor of cardiovascular diseases.
The research on the PWV influence factors by Japan Qianye university and Cihui doctor, found that the factors clinically influencing PWV can be basically divided into physiological factors (such as sex, age, immediate blood pressure) and pathological factors (such as hypertension, hyperlipidemia, diabetes, arteriosclerosis, end-stage renal disease, etc.). Physiological factors are invariable factors, age is slowly-varying factors, and the influence of the physiological factors on the elasticity and toughness of the artery and the relation of the PWV have strong regularity and can be obtained by a statistical method. Blood pressure is a transient factor, and PWV is affected by blood pressure fluctuation caused by external stimuli (such as exercise, drugs, drinking, etc.). However, the change of PWV caused by physiological factors has a small correlation with the lesion of the artery wall, and is not suitable for detecting cardiovascular and cerebrovascular diseases. Currently there is no internationally recognized method or formula that can well rule out the effects of physiological factors, especially instantaneous blood pressure, on PWV. How to effectively eliminate the influence of gender, age and instant blood pressure so as to better extract the pathological change of PWV is an urgent problem to be solved.
Disclosure of Invention
Aiming at the defects in the prior art, the invention provides a method for correcting the influence of age, sex and blood pressure on the pulse wave propagation speed, and the method can eliminate the influence of physiological factors such as age, sex and instant blood pressure on PWV and better reflect the pathological change of PWV.
A method of correcting the influence of age, sex and blood pressure on the pulse wave propagation velocity, characterized by: the method comprises the following steps:
s1) establishing a function family between PWV and blood pressure of the population without arteriosclerotic lesions, and obtaining function parameters corresponding to each age and sex to form a parameter database;
s2) establishing a normalized model of the PWV under the fixed age, gender and blood pressure states;
s3) obtaining correction amounts of PWV with respect to age, sex and blood pressure;
s4) corrects the measured PWV with correction amounts for age, sex, and blood pressure.
A functional family between PWV and blood pressure of the arteriosclerotic lesion-free population in step S1 is established using the following relationship:
wherein PWV is the pulse wave propagation velocity and BP is the blood pressure; i represents age, j represents gender; k is a radical ofijAnd bijIs a functional parameter related to gender and age.
K isijAnd bijObtained by the following method:
for each age and sex, a population without arteriosclerotic lesions (number of samples) was obtained>30) Blood pressure BP and PWV corresponding to it, which vary widely; obtaining a function parameter k corresponding to each age and gender by a curve fitting methodijAnd bijForming a database K of parametersijAnd Bij。
Wherein, i is 1,2, …, n (1 is not less than n is not more than 100); j-M/F (M is male and F is female).
The method for obtaining the blood pressure BP with wide variation of the population without the arteriosclerotic lesion and the PWV corresponding to the blood pressure BP comprises the following steps:
selecting a crowd needing a surgical operation and without an arteriosclerotic focus as an acquisition object, and monitoring and recording arterial blood pressure in an operation anesthesia process in real time through arterial puncture;
meanwhile, collecting PWV corresponding to the arterial blood pressure time; PWV is obtained by detecting the pulse wave propagation time PTT and the propagation distance L, and by the following relationship:
in step S2, a normalized model of PWV at a fixed age, gender and blood pressure is established by:
selecting a function parameter k with age x and gender MxMAnd bxM(ii) a Selecting a blood pressure state BPx, calculating PWV at BPxxM:
In step S3, correction amounts of PWV with respect to age, sex, and blood pressure are obtained by normalizing the model:
in the blood pressure BPx state, the correction amount of PWV relative to age and sex is Δ PWV for the non-arteriosclerosis lesion group with age i and sex j relative to the non-arteriosclerosis lesion group with age x and sex M1：
The actual blood pressure of a group without arteriosclerotic lesions of age i and sex j is BPm, and the correction amount of PWV relative to the selected blood pressure BPx is delta PWV2：
In step S4, PWVm actually measured by the subject aged i and sexed j is corrected by the correction amount in step S3, and the corrected PWVr is:
the invention has the following beneficial effects:
the invention can eliminate the influence of physiological factors such as age, sex, instant blood pressure and the like on PWV, better reflect the change of PWV caused by pathological factors such as hypertension, hyperlipidemia, diabetes, arteriosclerosis, end-stage nephropathy and the like, and enable the evaluation of arteriosclerosis to be more accurate.
Drawings
FIG. 1 is a graph of sensitivity and specificity (ROC curve) of uncorrected PWVm for detecting atherosclerosis.
FIG. 2 is a graph of sensitivity and specificity (ROC curve) of PWVr in detecting atherosclerosis corrected by the method of the invention.
Detailed Description
The invention provides a method for correcting the influence of age, sex and blood pressure on the pulse wave propagation speed, which is characterized by comprising the following steps: the method comprises the following steps:
s1) establishing a function family between PWV and blood pressure of the population without arteriosclerotic lesions, and obtaining function parameters corresponding to each age and sex to form a parameter database;
establishing a family of functions requires establishing through the following relationships:
wherein PWV is the pulse wave propagation velocity and BP is the blood pressure; i represents age, j represents gender; k is a radical of formulaijAnd bijIs a functional parameter related to gender and age. Wherein k isijAnd bijThe acquisition of (2) requires obtaining a population without arteriosclerotic lesions (number of samples) for each age and sex>30) Blood pressure BP and PWV corresponding to it, which vary widely; obtaining a function parameter k corresponding to each age and gender by a curve fitting methodijAnd bijForming a database K of parametersijAnd Bij；
Wherein, i is 1,2, …, n (1 is not less than n is not more than 100); j-M/F (M is male and F is female).
The method for obtaining the blood pressure BP widely varying in the population without the arteriosclerotic lesion and the PWV corresponding to the blood pressure BP comprises the following steps:
selecting a crowd needing a surgical operation and without an arteriosclerotic focus as a collection object, and monitoring and recording arterial blood pressure in an operation anesthesia process in real time through arterial puncture (under the multiple actions of an anesthetic, a vasoactive drug and an operation, the blood pressure in the operation fluctuates in a large range, and the change range can meet the requirement of curve fitting);
meanwhile, collecting PWV corresponding to the arterial blood pressure time; PWV is obtained by detecting the pulse wave propagation time PTT and the propagation distance L, and by the following relationship:
the means for detecting the pulse wave may include any one or more of the following: pressure sensors, photoplethysmography (PPG) or impedance plethysmography;
the method for obtaining the pulse wave propagation time PTT comprises the following steps: PTT can be obtained by simultaneous measurement of ECG, PPG, and ICG: firstly, obtaining the arrival time PAT of pulse propagation through ECG and PPG, wherein the PAT is defined as the time interval between the peak of an R wave of the ECG and the starting point of a PPG pulse wave signal; the pre-ejection PEP is then determined by ECG and ICG, PTT equals PAT minus PEP;
the PTT can also be obtained by synchronously detecting a PPG pulse wave signal at the proximal end and a PPG pulse wave signal at the distal end according to the time difference between the two pulse wave signals; the sites where the PPG signal is detected are preferably the ears and toes; specific identification methods for PTT can be understood by reference to YAN CHEN, CHANGYUN WEN, GUOCAI TAO, and MIN BI "Continuous and Noninival measurements of Systolic and Diastolic Blood Pressure by One film physical Model with the Same Model Parameters and Two Separate Pulse Wave sources 2012;
the pulse wave propagation distance L can be obtained by actual measurement, or can be estimated by subtracting a fixed constant from the percentage of the height or the height.
S2) establishing a normalized model of PWV at a fixed age, gender and blood pressure:
selecting a function parameter k with age x and gender MxMAnd bxM(ii) a Selecting a blood pressure state BPx, calculating PWV under BPxxM:
S3) obtaining correction amounts of PWV with respect to age, sex and blood pressure;
in the blood pressure BPx state, the correction amount of PWV relative to age and sex is Δ PWV for the non-arteriosclerosis lesion group with age i and sex j relative to the non-arteriosclerosis lesion group with age x and sex M1：
The actual blood pressure of the patient without arteriosclerosis lesion is BPm, the age is i years, the sex is j, and the correction quantity of PWV is delta PWV relative to the selected blood pressure BPx2：
S4) correcting the measured PWV with correction amounts for age, gender, and blood pressure:
PWVm actually measured by the subject aged i and sexed j is corrected by the correction amount in step S3, and the corrected PWVr is:
the method can eliminate the influence of age, sex and instant blood pressure and obtain the change of pulse wave propagation speed caused by pathological factors.
The above method is explained in detail by taking an example as follows:
this example shows how the method of the present invention can be used to correct PWV measured in a subject, to exclude the effects of age, sex, and blood pressure, and to obtain pathological changes in PWV.
The present embodiment employs an infrared photoplethysmography (PPG) to detect pulse wave signals of ears and toes of a subject to be measured, obtains a pulse wave propagation time PTT from a time difference between two pulse wave signals, and obtains PWV by the following relationship:
the propagation distance is determined by: l is-0.3 m in height.
Selecting a crowd needing a surgical operation and without an arteriosclerotic focus as an acquisition object, and monitoring and recording arterial blood pressure in an operation anesthesia process in real time through arterial puncture; and synchronously recording the PWV obtained by the method, and establishing a function family between the PWV of the population without the arteriosclerosis focus and the blood pressure and a function parameter database corresponding to each age and gender.
Then selecting a standard age, gender and pulse wave propagation distance L to establish a normalized model:
this embodiment selectsThe fixed age is 40 years old, and the gender is the mathematical model parameter of the male. In the above-mentioned established KijAnd BijK in the function parameter database for males aged 4040MAnd b40M11.2 and 255 respectively (as long as a function parameter database is established according to the steps provided by the invention, relevant specific numerical values can be obtained); the selected blood pressure state was the mean arterial pressure of 90 mmHg. The selected height is 1.7 m, and the pulse wave propagation distance L is 1.7-0.3-1.4 m. The normalized model of PWV is then:
the existing test subject with age of 60 years, sex of woman and height of 1.6 m (pulse wave propagation distance L is 1.6-0.3-1.3 m) has mathematical model parameter k60FAnd b60F12.7 and 242 respectively (may be at established K)ijAnd BijQueried in a function parameter database); when the actually measured mean arterial pressure is 102mmHg and the actually measured pulse wave propagation time PTT is 78 milliseconds, PWVm (m/s) is:
the corrected PWVr (m/s) is:
the 60 year old female received carotid ultrasound examination and the results showed: the carotid artery has normal vessel malformation, a thick intima-media, normal inner diameter of a vessel cavity and no abnormal echo in the vessel cavity, and obviously the subject does not have a typical arteriosclerosis focus. The actually measured PWvm is 16.67 m/s, which is obviously higher than that of normal people, reaches the standard of arteriosclerosis and is inconsistent with the result of ultrasonic imaging examination; however, the corrected PWVr was 12.72 m/s, which was not very different from the normal one, indicating that the subject did not develop significant arteriosclerosis, consistent with the results of the ultrasonography.
Fig. 1 and 2 show sensitivity and specificity curves (ROC curves) for uncorrected PWVm and PWVr corrected by the method of the invention for detecting atherosclerosis, respectively. Clearly, PWVr has higher specificity and sensitivity than PWVm (area 0.815vs 0.613 under ROC curve).
Finally, it should be noted that: the above embodiments are only used to illustrate the technical solution of the present invention, and not to limit the same; while the invention has been described in detail and with reference to the foregoing embodiments, it will be understood by those skilled in the art that: the technical solutions described in the foregoing embodiments may still be modified, or some or all of the technical features may be equivalently replaced; such modifications and substitutions do not depart from the spirit and scope of the present invention, and they should be construed as being included in the following claims and description.
Claims (5)
1. A method of correcting the influence of age, sex and blood pressure on the pulse wave propagation velocity, characterized by: the method comprises the following steps:
s1) establishing a function family between PWV and blood pressure of the population without arteriosclerotic lesions, and obtaining function parameters corresponding to each age and sex to form a parameter database;
s2) establishing a normalized model of the PWV under the fixed age, gender and blood pressure states;
s3) obtaining correction amounts of PWV with respect to age, sex and blood pressure;
s4) correcting the measured PWV with correction amounts for age, sex, and blood pressure;
a functional family between PWV and blood pressure of the arteriosclerotic lesion-free population in step S1 is established using the following relationship:
wherein PWV is the pulse wave propagation velocity and BP is the blood pressure; i representsAge, j represents gender; k is a radical ofijAnd bijIs a function parameter related to gender and age;
k is the same asijAnd bijObtained by the following method:
acquiring blood pressure BP and PWV corresponding to the blood pressure BP which are widely changed by people without arteriosclerotic lesions according to each age and sex; obtaining a function parameter k corresponding to each age and gender by a curve fitting methodijAnd bijForming a database K of parametersijAnd Bij；
Wherein i is 1,2, …, n, 1 is less than or equal to n is less than or equal to 100; j is M/F, M is male, F is female.
2. The method of claim 1, wherein the influence of age, sex and blood pressure on the pulse wave velocity is corrected by: the method for obtaining the blood pressure BP with wide variation of the population without the arteriosclerotic focus and the corresponding PWV comprises the following steps:
selecting a crowd needing a surgical operation and without an arteriosclerotic focus as an acquisition object, and monitoring and recording arterial blood pressure in an operation anesthesia process in real time through arterial puncture;
meanwhile, collecting PWV corresponding to the arterial blood pressure time; PWV is obtained by detecting the pulse wave propagation time PTT and the propagation distance L, and by the following relationship:
3. the method of claim 1, wherein the influence of age, sex and blood pressure on the pulse wave velocity is corrected by:
in step S2, a normalized model of PWV at a fixed age, gender and blood pressure is established by:
selecting a function parameter k with age x and gender MxMAnd bxM(ii) a Selecting a blood pressure state BPx, calculating PWV under BPxxM:
4. A method for correcting the influence of age sex and blood pressure on the pulse wave propagation velocity according to claim 3, wherein:
in step S3, correction amounts of PWV with respect to age, sex, and blood pressure are obtained by normalizing the model:
in the blood pressure BPx state, the correction amount of PWV relative to age and sex is Δ PWV for the non-arteriosclerosis lesion group with age i and sex j relative to the non-arteriosclerosis lesion group with age x and sex M1：
The actual blood pressure of the patient without arteriosclerosis lesion is BPm, the age is i years, the sex is j, and the correction quantity of PWV is delta PWV relative to the selected blood pressure BPx2：
5. The method of claim 4, wherein the influence of age, sex and blood pressure on the pulse wave velocity is corrected by:
in step S4, the PWVm actually measured by the subject aged i and sexed j is corrected by the correction amount in step S3, and the corrected PWVr is:
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