剪切率对肾移植患者颈动脉内中膜厚度的影响  

Effects of carotid shear rate on carotid intima-media thickness in kidney transplant recipients

作　　者：李朝军[1] 李凡[1] 秦燕[2] 张茜[3] 高峰[1] 杜联芳[1] 罗向红[3] Li Zhaojun;Li Fan;Qin Yan;Zhang Qian;Gao Feng;Du Lianfang;Luo Xianghong(Department of Ultrasound,Shanghai General Hospital,Shanghai Jiaotong University,Shanghai,200080,China)

机构地区：[1]上海交通大学附属第一人民医院超声科,200080 [2]上海交通大学附属第一人民医院泌尿外科,200080 [3]上海交通大学附属第一人民医院心脏超声室,200080

出　　处：《中华医学超声杂志（电子版）》2017年第6期446-451,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：上海市科学技术委员会医学引导类科技项目(15411969100;16411969300);上海交通大学医工交叉研究基金(YG2015MS28);上海市卫生和计划生育委员会基金(201440290;201640043);促进市级医院临床技能与临床创新能力三年行动计划(16CR3105B)

摘　　要：目的分析终末期肾病(ERSD)和肾移植患者颈动脉内中膜厚度(IMT)与剪切率(SR)的关系,探讨SR对颈动脉IMT的影响。方法选择2014年3月至2015年12月于上海交通大学附属第一人民医院肾移植患者31例(肾移植组)和ESRD患者31例(ESRD组),同时选择同期体检的84名健康志愿者作为健康对照组。测量所有受试者双侧颈动脉IMT和SR。采用单因素方差分析比较3组受试者颈动脉IMT、颈动脉SR差异,进一步组间两两比较采用SNK-q检验;采用直线回归分析分析健康对照组受试者、ESRD组、移植肾组患者颈动脉SR与双侧颈动脉IMT的相关性。结果 ESRD组、肾移植组患者、健康对照组受试者右侧颈动脉IMT分别为(561.9±147.7)、(480.5±90.3)、(529.7±131.8)μm。ESRD组患者右侧颈动脉IMT均较肾移植组患者、健康对照组受试者厚,且差异均有统计学意义(q=1.923,P=0.050,q=1.969,P=0.044),而肾移植组患者与健康对照组受试者右侧颈动脉IMT差异无统计学意义。ESRD组、肾移植组患者、健康对照组受试者左侧颈动脉IMT分别为(517.5±164.7)、(506.7±126.3)、(467.0±106.4)μm,3组间差异无统计学意义。ESRD组、肾移植组患者、健康对照组受试者右侧颈动脉SR分别为(134.01±56.4)、(133.4±43.7)、(175.8±68.3)s-1。ESRD组、肾移植组患者右侧颈动脉SR均小于健康对照组受试者,且差异均有统计学意义(q=3.133,P=0.002;q=3.470,P<0.001),而ESRD组、肾移植组患者右侧颈动脉SR差异无统计学意义。ESRD组、肾移植组患者、健康对照组受试者左侧颈动脉SR分别为(146.3±55.9)、(138.5±43.8)、(154.7±60.8)s-1,3组间差异无统计学意义。健康对照组、ESRD组和移植肾组受试者颈动脉SR与颈动脉IMT呈线性负相关(右侧:r=-0.384、-0.082、-0.454;左侧:r=-0.572、-0.223、-0.276,P均<0.05)。结论 ERSD患者颈动脉IMT增厚,肾移植后患者颈动脉IMT部分改善,这种变化与血流SR相关。Objective To analyze the relation between carotid intima-media thickness（IMT） and the shear rate（SR）, and to explore the effect of SR on IMT in the patients with end-stage renal disease（ESRD） and the kidney transplant recipients（KTR）. Methods From March 2014 to December 2015, 31 KTR and 31 patients with ESRD supported by hemodialysis and 84 control subjects underwent an carotid ultrasound in Shanghai General Hospital affiliated to Shanghai Jiaotong University. Bilateral carotid IMT and SR were measured. The differences of IMT and SR in three groups were compared by single factor analysis of variance. SNK-q test was used to compare the two groups. The correlation between SR and bilateral IMT was analyzed by linear regression analysis in healthy control group, ESRD group and KTR group. Results On the right, in ESRD, KTR and control group, the IMTs were（561.9±147.7） μm,（480.5±90.3） μm and（529.7±131.80） μm respectively. Compared with KTR and control group, the IMT on right was thickest in ESRD, but there was no significant difference between KTR and control group in right IMT. On the left, the IMTs were（517.5±164.7） μm,（506.7±126.3） μm and（467.0±106.4） μm in control group, ESRD and KTR, respectively. Among groups, there was no significant difference. On the right, the SRs were（134.01±56.4） s-1,（133.4±43.7） s-1 and（175.8±68.3） s-1 in ESRD, KTR and control group, respectively. In ESRD and KTR groups, the SR of the right carotid artery was less than that of the control group, and had significant difference（q=3.133, P=0.002; q=3.470, P〈0.001）. There was no significant difference in right SR between ESRD and KTR. On the left, the SRs were（146.3±55.9） s-1,（138.5±43.8） s-1 and（154.7±60.8） s-1 in ESRD, KTR and control group, respectively, and had no significant difference. There was linear negative correlation between SR and IMT in healthy control group, ESRD group and KTR group, respectively（right： r=-0.384,-0.082,-0.454; left： r=-

关 键 词：肾移植 肾病 颈动脉 内中膜厚度 剪切率 

分 类 号：R445.1[医药卫生—影像医学与核医学] R699.2[医药卫生—诊断学]