慢性肾功能衰竭患者血脂与颈动脉硬化的关系

The Relation of Blood Lipid and Carotid Atherosclerosis in Chronic Renal Failure Patients

[目的]研究慢性肾功能衰竭维持性血液透析患者与非透析患者血脂与颈动脉硬化的关系.[方法]收集27例慢性肾功能衰竭维持性血液透析患者(A组)、27例配对对照者及25例非透析患者(B组)、25例配对对照者,查血TC,TG,HDL-C,LDL-C,Apo-A1,ApoB及Lipoprotein(a)[LP(a)];彩超观测双侧颈总动脉、颈动脉分叉处及颈内动脉的解剖及血流动力学情况,包括斑块,最大(Vmax)和最小血流速度(Vmin)(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]A组HDL-C较对照组显著降低,LP(a)显著增高(均P＜0.01);B组Apo-B、TG、LDL-C、LP(a)显著增高(P＜0.01～0.05),HDL-C显著降低(P＜0.01),A组和B组血脂结果比较未见显著性差异(P＞0.05);A组与其对照组相比平均IMT、最大IMT、RI、斑块发生率均显著增高(P＜0.01);Vmin显著降低(P＜0.01).B组与其对照组相比平均IMT、最大IMT、斑块发生率均显著增高(P＜0.01),A组较B组Vmin显著降低(P＜0.01);颈动脉斑块阴性组和阳性组患者血脂结果比较未见明显差异;斑块阳性组患者较阴性组平均IMT、最大IMT均有显著性增厚;A组和B组LDL-c、Lp(a)、Apo-B分别与平均IMT、最大IMT呈正相关(P＜0.05).[结论]慢性肾功能衰竭维持性血液透析患者和非透析患者存在血脂异常和动脉硬化,并存在一定关系,纠正血脂异常有可能改善慢性肾功能衰竭维持性血液透析患者和非透析患者的生存率.

[Objective]To study the relationship of blood lipid and color ultra-sound indicators of carotid atheroselerosis in chronic renal failure patients including hemodialysis patients and non-dialysis patients. [Methods]Twenty-seven hemodialysis patients, 25 non-dialysis patients, and the same number of controlled patients were collected respectively. TC, TG, HDL-C, LDL-C, Apo-Al, Apo-B, LP（a） were detected. Color ultra-sound indicators included plaque, maximum and minimum blood velocity, IMT,RI of bilateral carotid arteries. [Results]The levels of HDL-C decreased, while LP（a） increased significantly in hemodialysis CRF patients compared to the control group. The levels of TG, LDL-C, LP（a） and ApoB increased and HDITC decreased significantly in non-dialysis CRF patients compared to the control group. The level of TG,CHO, HDL- C, LDL-C, LP（a）,ApoB and ApoA1 showed no obvious differences between hemodialysis CRF patients and non-dialysis CRF patients. The level of average IMT, maximum IMT , RI and incidence of eoratid plaque increased, while V（min） deceased significantly in both hemodialysis CRF patients and non-dialysis CRF patients compared to the control group. The level of V（min） decreased obviously in hemodialysis CRF patients compared to non-dialysis CRF patients. The level of average IMT, maximum IMT increased significantly in plaque positive patients compared to the negative patients. The levels of LDL-C, LP（a） and ApoB respectively positively related to the level of average IMT, maximum IMT in hemodialysis CRF patients. The levels of LDL-C, LP（a） and ApoB respectively positively related to the level of average IMT, maximum IMT in non-dialysis CRF patients. [ConelusionlAbnormal blood lipid level and arteriosclerosis exist in hemodialysis and non-dialysis CRF patients. Arteriosclerosis is associated with abnormal blood lipid level. To correct the abnormality of blood lipid may improve survival rate in hemodialysis and non-dialysis CRF patients.