不同病因尿毒症患者肱动脉内-中膜厚度与内皮舒张功能的临床研究

Study of intima-media thickness of brachial artery and endothelial function in patients with uremia

[目的]探讨不同病因所致尿毒症行维持性血液透析(MHD)患者肱动脉内-中膜厚度(IMT)与内皮舒张功能(EDD)间有无差异。[方法]应用高分辨率超声诊断仪,对51例应用动静脉内瘘行MHD的尿毒症患者(其中高血压肾病所致16例、糖尿病肾病所致15例、慢性肾小球肾炎所致20例)和30例正常对照组,检测尿毒症MHD患者无动静脉内瘘侧肱动脉及健康人右侧肱动脉IMT、基础内径、反应性充血后内径并计算肱动脉EDD。[结果]在高血压肾病、糖尿病肾病和慢性肾小球肾炎所致尿毒症MHD患者中,三组的EDD与健康对照组比较(14.98±4.87)%,差异有显著性意义(P<0.01);糖尿病肾病组的EDD(4.78±0.85)%与高血压肾病组(7.39±1.54)%和慢性肾小球肾炎组(7.81±2.11)%比较,差异有显著性意义(P<0.01),高血压肾病组与慢性肾小球肾炎组EDD比较,差异无显著性意义(P>0.05)。高血压肾病组(0.38±0.10)mm、糖尿病肾病组(0.46±0.07)mm、慢性肾小球肾炎组(0.40±0.10)mm的IMT与健康对照组(0.28±0.09)mm比较,差异有显著性意义(P<0.01);三组病例组间的IMT比较,差异无显著性意义(P>0.05)。[结论]不同病因所致尿毒症MHD患者中,糖尿病肾病所致尿毒症EDD受损最严重,而三组病例组间IMT无差异。

[Objective] The study examines the brachial artery intima-media thickness（IMT）and endothelium-dependent dilation（EDD） in patients with maintenance hemodialysis（MHD）of uremia.[Methods] With high frequency ultrasound,the brachial artery IMT and EDD in 51 patients with arterio-venous fistula of MHD of uremia were evaluated.Of them,16 had hypertentive nephropathy,15 had diabetic nephropathy and 20 had chronic glomerulonephritis.Thirty healthy subjects were selected as control.Measurements of brachial artery IMT and diameter were performed by high resolution ultrasonography during baseline and reactive hyperemia in 51 patients with MHD of uremia and 30 healthy subjects.Percent changes in brachial artery diameter induced by reactive hyperemia were calculated.[Results] Brachial artery EDD in diabetic nephropathy group（4.78±0.85） %,hypertentive nephropathy group（7.39±1.54） % and chronic glomerulonephritis group（7.81±2.11） % were significantly less than that in healthy subjects（14.98±4.87） %（P0.01）,but brachial artery IMT in hypertentive nephropathy group（0.38±0.10） mm,diabetic nephropathy group（0.46±0.07） mm and chronic glomerulonephritis group（0.40±0.10） mm were significantly more than that in healthy subjects（0.28±0.09） mm（P0.01）.Brachial artery EDD in diabetic nephropathy group（4.78±0.85）% was significantly less than that in hypertentive nephropathy group（7.39±1.54）% and chronic glomerulonephritis group（7.81±2.11）%（P0.01）,but IMT had no significant difference among three groups（P0.05）.[Conclusion] Brachial artery EDD in diabetic nephropathy group is impaired most seriously,but IMT has no significant difference among three groups.