血透患者合并动脉硬化与脑梗死的临床研究

The Association of Peripheral Artery Atherosclerosis with Cerebral Infarction in Hemodialytic Patients

目的：探讨血液透析患者外周动脉粥样硬化、脑梗死等的相关因素和预警因子。方法：42例血液透析患者(血透组)及42例年龄、性别相同的健康志愿者(对照组),检测血清C反应蛋白(CRP)、血脂；并用彩色超声多普勒检测颈、股动脉后壁内中膜复合体厚度(IMT)并行斑块积分；颅脑CT扫描探查有无脑梗死灶。所获结果应用SPSS10.0统计软件分析。结果：与对照组相比,血透组CRP阳性率高(33.3% vs 0%,P＜0.001)；颈动脉、股动脉后壁IMT增厚(分别为1.52±0.49 m vs 0.88±0.26 mm,P＜0.001；1.37±0.48 mm vs 0.86±0.33mm,P＜0.05),斑块积分增高(分别为4.00±3.03 vs 0.43±0.96,P＜0.001；1.45±1.91 vs 0.24±0.86,P＜0.05)；脑梗死患病率高(28.6% vs 0%,P＜0.001)。结论：动脉粥样硬化是血透患者的常见并发症,其严重程度与脑梗死患病率明显相关。彩色多普勒检查可用于监测血透患者外周大中型血管动脉粥样硬化程度,并为早期应用脑梗死预防干预措施提供相应依据。

Objective：Cerebral infarction is frequently seen in haemodialytic patients, we investigated the characteristics peripheral artery atherosclerosis and cerebral infarction, in order to explorate association between them. Methods： In 42 patients with end-stage renal disease who underwent haemodialysis therapy（HD group） and 42 age-matched healthy （control group）, color Doppler ultrasonography was performed to check the atherosclerotic plaque of paries posterior of carotid and femoral ar teries and Gofmar＇s index, CT for cerebral infarction. Results：Compared with control group, the patients in HD group showed thicker atherosclerotic plaque of paries posterior of carotid and femoral arteries （ 1.52± 0. 49 mm vs 0. 88± 0. 26 mm, P〈0. 001 ; 1.37± 0.48mm vs 0. 86±0.33mm, P〈0.05, respectively） ,higher Gofmaris index （4. 00±3.03 vs 0. 43 ± 0.96, P〈0. 001 ; 1.45 ±1.91 vs 0. 24 ± 0. 86, P〈0.05 ,respectively） ,higher positive rate of C-reactive protein （33. 3% vs 0%, P〈0. 001 ） ;higher incidence of cerebral infarction （28.6% vs 0% ,P〈0. 001）. Atherosclerotic plaques of carotid and femoral arteries demonstrate mixed echogenicity. Concittsion：Atherosclerosis is a common complication, and significant carotid artery stenosis or ulcerations releasing microemboli to the brain are responsible for many occlusive cerebrovascular diseases. Color Doppler ultrasonography may be used for detection of atherosclerosis in hemodialytic patients, and providing evidence for working out therapeutic schedule.