维持性血液透析患者颈动脉硬化及相关因素分析

The research of carotid atherosclerosis and its relative factors of hemodialysis patients

目的 研究慢性肾衰竭维持性血液透析患者颈动脉硬化程度及相关因素分析。方法 收集 13例慢性肾衰竭维持性血液透析患者及 13例配对对照者性别、年龄、体重、身高、BMI及病程等一般临床资料 ;抽前臂静脉血查血红蛋白 (Hb)、尿素氮 (BUN)、肌酐 (SCr)、白蛋白 (Alb)、前白蛋白 (PA)、总胆固醇 (TC)、甘油三酯 (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)、血浆纤维蛋白原、补体C3、载脂蛋白A1(Apo -A1)、载脂蛋白B(ApoB)及脂蛋白 (a) [Lp (a) ];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、最大 [(MaximumVelocity ,V(max) ]和最小血流速度 [(MinimumVelocity ,V(min) ](即收缩期和舒张期峰值血流速度 ) ,血管内皮厚度 (即内膜 -中膜厚度 ,IMT) ,阻力指数 (RI)。结果 慢性肾衰竭维持性血液透析组与对照组比较收缩压、舒张压和CRP均显著增高 (P <0 .0 1) ;Hb显著降低 (P <0 .0 5 ) ;Alb和PA显著降低 (P <0 .0 1)。原发疾病为高血压的患者CRP较原发疾病为慢性肾炎患者显著升高 (P <0 .0 1)。高血压组斑块发生率明显增高 (P <0 .0 1)。慢性肾衰竭维持性血液透析组平均IMT、最大IMT、V(min)、RI、斑块发生率与对照组相?

Objective To compare and study the relationships of the general clinical conditions, hematobiochemical indicators and color ultra-sound indicators of carotid atherosclerosis in hemodialysis patients. Methods The general clinical conditions, hematobiochemical parameters and color ultrasound parameters of 13 hemodialysis patients and 13 controlled patients were collecled. General clinical conditions included body weight, height and BMI. Hematobiochemical pareters included Hb, Alb, PAB, TC, TG, HDL-C, LDL-C, CRP, plasma fibrinogen, C3,Apo-A1, Apo-B, LP(a). Color ultrasound parameters included plaque, maximum and minimum blood velocity, thickness of vascular endothelium (IMT), resistant index(RI) of bilateral carotid. Results Compared with the controlled group hemodialysis patients: systolis blood pressure and diastolic blood pressure increased significantly while Hb decreased significantly (P<0.05); Alb and PAB both decreased significantly (P<0.01);CRP increased significantly (P<0.01). There were different CRP level and plaque incidence rate in patients with different primary diseases. Those of hypertension group were higher than those of chonic nephritis group(P<0.01). Average IMT, Maximum IMT, V(min), RI and plaque incidence rate of hemodialysis were patients significantly higher than the controlled group (P<0.01)There were significant difference of Age, SP, Alb, PAB, LP(a) and CRP between plaque-negative group and plaque-positive group(P<0.05). Average IMT and Maximum IMT increased significantly in plaque-positive group (P<0.05). In hemodialysis group, CRP had negative relationship with PAB (r = 0.676, P<0.05). Lp(a) had positive relationship with Maximum IMT (r=0.714, P<0.01). Conclusions There are relationships among malnutrition, inflammation and atherosclerosis in hemodialysis patients. Interdiction of the relationship may play a very important role in ameliorating the prognosis of the hemodialysis patients.