摘要
目的超声检测维持性血透(MHD)患者颈动脉动脉粥样硬化情况并分析其血流动力学参数与影响因素。方法75例MHD患者。采用高频B超检测其颈动脉粥样硬化斑块情况及血流动力学参数,并记录临床及生化数据,按斑块有无分为阳性组和阴性组。对两组各数据进行比较,并对斑块产生的各危险因素进行Lo-gistic回归分析。结果MHD患者颈动脉斑块发生率为49.33%。好发于颈总动脉窦部及主干。与斑块阴性组患者相比,阳性组患者颈总动脉内径增大(P=0.013)、颈动脉内膜中层厚度(IMT)明显增厚(P<0.001)。血流动力学参数分析提示舒张末期血流速度(Ved)明显降低(P=0.001),阻力指数(RI)明显升高(P=0.004),搏动指数(PI)升高(P=0.037),剪切率(SR)降低(P=0.023)。两组年龄、收缩压、血浆前白蛋白、血磷水平均有显著差异(P均<0.01)。斑块阳性组的KT/V值低于阴性组(P=0.021)。Logistic多元回归分析结果提示高收缩压(β=0.097,P=0.037)和高血磷水平(β=2.800,P=0.049)是颈动脉斑块发生的主要危险因素。结论MHD患者颈动脉粥样硬化斑块产生与高收缩压和高血磷密切相关,其血流动力学基础特征在于血流阻力增加导致血流流速减慢,剪切应力降低。
Purpose To investigate the relationship between atherosclerosis of carotid artery and its major risk factors as well as hemodynamics parameters analysis in maintenance hemodialysis（MHD） patients. Methods A study was carried out in seventy-five MHD patients. Atherosclerotic plaques of carotid artery and hemodynamics parameters were examined by high-resolution B-mode ultrasonograph in all patients. The clinical and biochemical characteristics were performed. The related data were analyzed between plaque positive group and plaque negative group. Results Atherosclerotic plaques distributing mainly in common carotid artery（CCA） especially in carotid bulbar were detected in 49.33% MHD patients. The internal diameter（P = 0.013） and intima-medial thickness（IMT）（P〈 0. 001） of CCA in plaque positive group were significantly greater than those in plaque negative group. The result of hemodynamics parameters analysis showed that the resistance index （RI） （P = 0. 004） and pulsatility index （PI） （P = 0. 037） were higher, meanwhile the flow velocity of end diastolic phase（Ved） （P = 0. 001） and shear rate（SR）（P = 0. 023） were lower in plaque positive group than in plaque negative group. The differences of age, SBP, levels of serum pre-albumin and serum phosphate between two groups were significant （P〈0.01）. The KT/V value was lower in plaque positive group than in plaque negative group （P = 0.021）. In Logistic multiple regression analysis, greater SBP（β= 0. 097,P= 0. 037）and greater serum phosphate level（β= 2. 800, P = 0. 049） were significantly risk factors for formation of atherosclerotic plaque in carotid artery, independent of other confounding risk factors. Conclusions The dramatic characteristics of hemodynamics were higher flow resistance, lower flow velocity and lower shear rate. Greater SBP and greater serum phosphate level were the mainly risk factors for formation of atherosclerotic plaque in carotid artery which may associate with CVD in MHD patients.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2006年第2期201-205,共5页
Fudan University Journal of Medical Sciences
关键词
血液透析
颈动脉
粥样硬化
血流动力学
hemodialysis
carotid artery
atherosclerosis
hemodynamics
