应用QAS及X-strain技术评价不同钙浓度透析液对维持性血液透析患者颈动脉弹性及形变能力的早期影响  

Evaluation the early effects of different calcium concentration on carotid artery elasticity and deformation capability in maintenance hemodialysis patients by QAS and X-strain technique

作　　者：邢雨薇[1] 郑敏[1] 李硕[2] 候利芳 孙素丽[1] ZHENG Min;XING Yu-wei;LI Shuo;HOU Li-fang;SUN Su-li(Department o f Ultrasound, the First Affiliated Hospital o f Harbin Medical University, Harbin 150001, China.)

机构地区：[1]哈尔滨医科大学附属第一医院超声科,哈尔滨150001 [2]哈尔滨医科大学附属第四医院超声科,哈尔滨150001 [3]哈尔滨医科大学附属第一医院体检中心,哈尔滨150001

出　　处：《中国循证心血管医学杂志》2016年第11期1369-1372,1385,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的采用血管硬度检测技术(QAS)及应变与应变率成像技术(X-strain)评价进行不同钙浓度维持性血液透析患者颈动脉的弹性和形变能力的早期改变。方法随机选择60例标准钙透析患者,根据即将使用透析液浓度的不同分为:低钙组(使用低钙透析液,钙1.25 mmol/L)、标准钙组(使用标准透析液,钙1.50 mmol/L),每组30例。检测患者生化指标:包括血钙、血磷、甲状旁腺素(PTH)水平等,行颈动脉常规超声测得内中膜厚度(IMT)、阻力指数(RI)等相关参数,应用QAS技术和X-strain技术检测两组患者双侧颈动脉,分别得出两组数据顺应性系数CC、膨胀系数DC、弹性系数(α)、弹性系数(β)、脉搏波传导速度(PWV)、反射波增强指数(Alx)和最大圆周应变(Cs)、最大圆周应变率(Csr)等参数,进行统计学分析,比较其差异并进行相关性分析。结果 1血液透析6个月后低钙组的血钙、血磷、钙磷乘积较标准钙组显著降低(P<0.05),而PTH水平显著升高(P<0.05)。2血液透析6个月后低钙组IMT、RI、α、β、PWV、Alx数值较标准钙组显著降低(P<0.05),而Cs、Csr数值显著升高(P<0.05)。3IMT、α、β、PWV、Cs、Csr之间有相关性。4血钙对颈动脉弹性功能的影响显著。结论 QAS技术及X-strain技术可以较早评价不同钙浓度维持性血液透析患者颈动脉弹性及形变能力,了解心血管疾病的发展情况,及早调整方案,有益于临床诊疗。Objective To evaluate the early effects of different calcium concentration on carotid arteryelasticity and deformation capability in maintenance hemodialysis patients by quantitative artery stiffness(QAS)andX-strain technique.Methods60calcium dialysis patients were Randomly divided into two groups according to thedialysate concentrations:low calcium group(1.25mmol/L)and standard calcium group(1.50mmol/L).Each grouphad30patients.Biochemical indexes including but not limited to calcium,phosphorus,parathyroid hormone(PTH)were measured.intim a-m edia thickness(IMT),resistance index(RI)and so on were m easured by carotid arteryultrasonography.Compliance coefficient(CC),distention coefficient(DC),stiffness param eter a,stiffness parameterp,pulse wave velocity(PWV),augmentation index(Alx),circum ferential strain(Cs)and circum ferential strainrate(Csr)were measured by QAS and X-strain and compared between two groups.Results①At6month after thehemodialysis,calcium,phosphorus and calcium-phosphorus product of the low calcium group were significantlydecreased than that of the standard calcium group,while PTH was increased(P<0.05).②At6month after thehemodialysis,the values of IMT,RI,a,p,PWV and Alx of the low calcium group were decreased than that of thestandard calcium group,while the values of Cs,Csr were increased(P<0.05).③There is a correlation among IMT,a,p,PWV,Cs and C sr.④Calcium has a significant impact on the carotid artery elasticity.Conclusion QAS andX-strain technology can early detect the effects of different calcium dialysate on carotid elasticity and deformationcapacity in m aintenance hem odialysis patients.It has im portant im plications for clinical timely adjustm ent ofdialysis programs,as well as prevention.

关 键 词：血液透析患者 超声 颈动脉 弹性 形变能力 

分 类 号：R543.4[医药卫生—心血管疾病]