超声评价透析类型与终末期肾病患者颈动脉粥样硬化的临床价值  

The clinical significance of ultrasound evaluation of dialysis type and carotid atherosclerosis in patients with end-stage renal disease

作　　者：向佳兵 高媛[1] XIANG Jiabing;GAO Yuan(Special Branch of No.962 Hospital of Combined Service Force Support Armed Forces of PLA,Heilongjiang,Harbin 150000,China)

机构地区：[1]中国人民解放军联勤保障部队第962医院特诊科

出　　处：《河北医药》2019年第21期3214-3218,共5页Hebei Medical Journal

摘　　要：目的探讨终末期肾病(ESRD)患者不同透析类型与颈动脉内膜中膜厚度(IMT)和颈动脉斑块之间的相关性。方法连续收集透析中心患者,血液透析(HD)患者50例,持续性非卧床腹膜透析(CAPD)患者52例,正常健康自愿者45例,使用高频超声检测受试者的颈动脉IMT及斑块形成情况,从而进行颈动脉动脉粥样硬化的评价。确定患者的颈动脉IMT及斑块情况,收集实验室检查指标:包括钙(Ca)、磷(P)、白蛋白(ALB)、高敏C-反应蛋白(hs-CRP)、血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、血红蛋白(HB)、尿酸(UA)、血尿素氮(BUN)、空腹血糖(FPG)、肌酐(CRE)等。结果透析组(HD组和CAPD组)与对照组比较:男性患者居多,透析组CRE、FPG、BUN、ALB、PUA、HB明显高于对照组(P<0.05);HD组与CAPD组比较:HD组中TG、BUN、ALB、UA明显高于CAPD组(P<0.05)。HD组,CAPD组和对照组的平均颈动脉IMT(m-CIMT)分别为(0.98±0.25)mm、(0.85±0.23)mm和(0.59±0.14)mm,HD组与CAPD组比较(P<0.05);HD组与对照组比较(P<0.05);CAPD组与对照组比较(P<0.05)。HD组与CAPD组比较,颈动脉斑块形成情况发生率更高(P<0.05)。线性回归及Logistic分析显示颈动脉平均IMT(β=0.249,P<0.05)和斑块形成情况(OR=4.10;95%CI:1.71~6.72;P<0.05)与透析类型独立相关。结论长期ESRD患者透析类型与动脉粥样硬化密切相关,透析可能是其动脉粥样硬化的独立预测因子;高频超声能简便、快捷的检测出透析患者颈动脉粥样硬化情况。Objective To investigate the correlation between different dialysis types and carotid intima-media thickness(IMT) as well as carotid plaque in patients with end-stage renal disease(ESRD).Methods A total of 50 patients with hemodialysis(HD group),52 patients with continuous ambulatory peritoneal dialysis(CAPD group),and 45 healthy volunteers(control group) were enrolled in the study. The high-frequency ultrasound was used to detect the carotid artery IMT and plaque formation to evaluate the severity of carotid atherosclerosis.The laboratory indexes including calcium(Ca),phosphorus(P)and albumin(ALB).High-sensitivity C-reactive protein(hs-CRP),serum total cholesterol(TC), triglyceride(TG),low-density lipoprotein(LDL),high-density lipoprotein(HDL),hemoglobin(HB), uric acid(UA),blood urea nitrogen(BUN),fasting blood glucose(FPG),creatinine(CRE) were detected and compared among the threee groups.Results The male patients in HD group and CAPD group were more than those in control group. The levels of mostly,CRE,FPG,BUN,ALB,P,UA,HB in HD group were significantly higher than those in control group.The levels of TG,BUN,ALB,and U in HD group were significantly higher than those in CAPD group. The mean carotid IMT values(m-CIMT) in HD group,CAPD group and control group were(0.98±0.25)mm,(0.85±0.23)mm,(0.59±0.14)mm,respectively,there were significant differences between HD group and CAPD group(P<0.05) and between HD group and control group(P<0.05).Moreover the incidence rate of carotid plaque formation in HD group was significantly higher than that in CAPD(63% vs 38%,P<0.05).Linear regression and logistic analysis showed that carotid mean IMT and plaque formation were independently associated with dialysis type(P<0.05).Conclusion The dialysis type in patients with long-term ESRD is closely related to atherosclerosis,and dialysis may be an independent predictor of atherosclerosis.High-frequency ultrasound can easily and quickly detect carotid atherosclerosis in dialysis patients.

关 键 词：超声 动脉粥样硬化 持续性非卧床腹膜透析 透析类型 终末期肾病 血液透析 

分 类 号：R445.1[医药卫生—影像医学与核医学]