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首钢医院王宏宇等提出全生命周期血管健康管理模式:北京血管健康分级法

2018-11-07 王宏宇 中国循环杂志

北京大学首钢医院血管医学中心王宏宇在本刊撰文指出,以全身血管床为核心,对不同部位血管病变和不同病变程度的人群,进行预防、治疗以及系统康复,并进行全生命周期的血管健康管理。

北京大学首钢医院血管医学中心王宏宇在本刊撰文指出,以全身血管床为核心,对不同部位血管病变和不同病变程度的人群,进行预防、治疗以及系统康复,并进行全生命周期的血管健康管理
 
目前,国际上存在多个预测心血管疾病风险的评分系统研究,包括Framingham 风险评分系统研究、ARIC研究、SCORE研究、Reynolds 危险评分系统研究等,然而每个评分系统都有其局限性。
 
他们总结多年临床科研经验后,基于2010~2016 年建立的血管健康状况管理数据库资料统计分析系列结果,提出了新的全生命周期血管健康管理的血管健康分级模式,即北京血管健康分级法(BVHS):

Ⅰ级: 正常: 结构和功能均正常。

Ⅱ级: 动脉内皮功能障碍: 无影像学证实的粥样硬化,FMD < 10%。

Ⅲ级: 动脉僵硬期: 无影像学证实的粥样硬化,PWV>9 m/s,CAVI>9。

Ⅳ级: 结构性血管病变早期: 影像学证实的动脉粥样硬化管腔狭窄<50%

  a: 动脉粥样斑块形成,弹性正常( PWV≤9 m/s,CAVI≤9)

  b: 动脉粥样斑块形成,弹性降低( PWV >9 m/s,CAVI>9)

Ⅴ级: 结构性血管病变中期

  a: 动脉粥样硬化形成,管腔狭窄50%~75%,弹性正常( PWV≤9 m/s,CAVI≤9)

  b: 动脉粥样硬化形成,管腔狭窄50%~75%,弹性降低( PWV > 9 m/s,CAVI>9)

Ⅵ级: 结构性血管病变晚期: 管腔狭窄> 75%( 心、脑、肾、下肢血管)

Ⅶ级: 临床血管事件期( 需紧急住院) : 血管性猝死、急性冠状动脉综合征、脑血管意外、下肢动脉闭塞。

BVHS 分级标准从血管功能和结构方面整合,综合评估全身血管床,早期无创检出亚临床血管性病变。
 
BVHS 在传统的危险因素基础之上,叠加了血管结构性和功能性评价指标,包括对血管内皮功能和动脉僵硬度的无创测定:包括血流介导的血管舒张功能(FMD)、颈-股动脉脉搏波传导速度(PWV)、心踝血管指数(CAVI)。

他认为,整体综合评估血管,及时干预、预防乃至逆转血管病变,将对于推动心脏和血管疾病的预防及诊治带来巨大变革。
 
而且,应用血管健康评估指标作为重要的心脑血管疾病替代性终点指标,可用于评估血管衰老和危险因素损伤导致的整体心脑血管疾病风险。

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    2018-11-07 smartxiuxiu

    其实挺佩服这个人一直坚持自己的奋斗

    0

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