摘要
目的:研究维持性血液透析(MHD)患者颈动脉硬化程度与左心室肥厚的关系。方法:收集48例MHD患者性别,年龄,体重,身高,BMI及病程等一般临床资料;静脉血查血红蛋白(Hb),尿素氮,肌酐,白蛋白,前白蛋白,总胆固醇,三酰甘油(TG),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C),C反应蛋白(CRP),彩色B型超声仪观测双侧颈总动脉、颈动脉分叉处及颈内动脉的解剖及血流动力学,包括斑块,血管内皮厚度(即内膜-中膜厚度,IMT)等,并用超声心动图测定患者心脏的左心室内径、左心房内径、左心室后壁厚度(LVPWT)、室间隔厚度、左心室射血分数等。结果:48例患者中有28例(58%)颈动脉斑块阳性,颈动脉斑块阳性组患者年龄大于颈动脉斑块阴性组(P<0·01),TC(P<0·01)、LDL-C(P<0·05)、CRP(P=0·01)、颈动脉内-中膜厚度(CCA-IMT)(P<0·01)及左室心肌质量指数(LVMI)(P<0·001)明显高于颈动脉斑块阴性组。性别分布、透析时间、收缩压、舒张压、脉压、TG、及Hb两组间无明显差异。48例患者中有37例(77%)有左室肥厚,左室肥厚组患者收缩压、舒张压及脉压明显高于无左室肥厚组(P<0·01);左室肥厚组高血压的发生率及LVMI明显高于无左室肥厚组(P<0·001),CCA-IMT明显高于无左室肥厚组(P<0·05),颈动脉斑块发生率明显高于无左室肥厚组(P<0·01),而Hb则明显低于无左室肥厚组(P<0·01)。两组之间在性别年龄分布、透析时间、CRP则无明显差别。相关性分析显示,LVMI与收缩压和脉压高度相关(P<0·001),与舒张压和CCA-IMT中度相关(P<0·01),与Hb呈负相关(P<0·01)。结论:MHD患者颈动脉硬化与左室肥厚关系密切,动脉硬化的治疗有可能预防和逆转MHD患者的左室肥厚。
Objective：Accelerated atherosclerosis is common in chronic haemodialysis （HD） patients. In this study, we aimed to investigate the relationship between left ventricular hypertrophy （LVH） in HD patients and carotid atherosclerosis. Methodology：Forty-eight patients with maintenance HD were enrolled in this study. Their biochemical parameters, including BUN, creatinine, albumin, haemoglobin, and C-reactive protein were examined by routine methods. The anatomy, hemodynamies, atheromatous plaque and intima thickness （IMT） of carotid were measured by high resolution B-mode ultrasonography. The left ventricular diameter （LVD） , left atrial diameter （LAD） left ventriadar mass index （LVMI） , left ventricular posterior wall thickness （LVPWT）, interventricular septal thickness （IVST）, and left ventricular ejection fraction （LVEF） were also detected by ultrasonic cardiography. Results：The LVH was detected in 37 of the patients （77%）. The plaque-positive was detected in 28 of the patients （58%）. The plaque-positive patients had higher LVMI （P 〈0. 001 ）, higher levels of serum cholesterol （P 〈 0. 01 ）, and low density lipoprotein cholesterol （ P 〈 0. 05 ） and thicker IMT （ P 〈 0. 01 ） than that in plaque-negative patients. The LVH-positive patients had higher LVMI（ P 〈0. 05 ）and IMT（P 〈0. 05 ）, and higher prevalence rate of hypertention （P 〈0. 001 ） than that in LVH-negative patients. The LVMI was correlated with systolic blood pressure （P〈0.001）, pulse pressure （P〈0.001）, and hemoglobin levels （P〈0.01）. Condusion：The carotid atherosclerosis is associated with LVH in maintenance HD patients. Whether the treatment of atherosclerosis may cause regression of or even prevent LVH in HD patients remains to elucidate.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2006年第6期525-529,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
血液净化
动脉粥样硬化
左室肥厚
颈动脉超声
hemodialysis atherosclerosis left ventricular hypertrophy carotid ultra-sound
