血液透析对肱动脉内皮功能影响的临床研究

Clinical Study on Effect of Hemodialysis on Endothelial Function of Brachial Artery

目的:通过观察不同透析时间患者肱动脉内皮功能,评价血液透析对血管内皮的影响及其时间变化规律。方法:利用高频超声,测量血液透析患者(HD组)、尿毒症非透析患者(pre-HD组)和健康志愿者(正常组)的肱动脉收缩期、舒张期内径及反应性充血后内径,计算肱动脉的扩张系数(DC)、僵硬度(SD)和血流介导的内径扩张值(FMD)。结果:与正常组相比,HD组和pre-HD组肱动脉DC值、FMD值减小,SD值增大,差异有统计学意义(P<0.01);HD组透析12月患者和pre-HD组患者间各项指标差异无统计学意义(P>0.05);透析36月肱动脉DC值、FMD值显著小于透析12月(P<0.01),SD值显著大于透析12月(P<0.01);透析60月与透析36月相比各观察指标差异无统计学意义(P>0.05)。结论:血液透析可以加重尿毒症患者内皮功能损伤,且这种作用与透析时间长短有一定关系。

Objective：To observe the endothelial function of brachial artery of the patients with different time,then evaluate the effect of hemodialysis on endothelial function and the role of different hemodialysis time.Methods：We measured systolic,diastolic and reactive hyperemic inner diameter of brachial artery in 60 hemodialysis patients（HD group）,20 predialysis patients（pre-HD group）and 20 healthy subjects（normal group）by using high resolution ultrasound.Distensibility coefficient,stiffness degree and flow-mediated dilatation were calculated.Results：Compared with normal group,the HD and pre-HD groups had lower DC,FMD and higher SD（P0.01）.There was no statistical difference of DC,SD and FMD level between the patients with hemodialysis for 12 months in HD group and the patients in pre-HD group（P0.05）.Compared with the patients with hemodialysis for 12 months,the patients with hemodialysis for 36 months had lower DC and FMD level,while had higher SD level（P0.01）.Comparing DC,SD and FMD value between the patients with hemodialysis for 36 months and for 60 months,there was no statistical difference（P0.05）.Conclusion：Hemodialysis could aggravate the injury of endothelial function in uremia patients,and the effect is correlated with hemodialysis time.