慢性肾病患者颈动脉粥样硬化的临床分析

Clinical analysis of carotid atherosclerosis in patients with chronic kidney disease

目的研究慢性肾病(CKD)患者颈动脉的结构、形态及血流动力学。方法将168例CKD患者根据肾小球滤过率(GFR)分为CKD2-3期组(59例)、CKD4期组(52例)和CKD5期组(57例),彩色多普勒超声检测双侧颈总动脉的内-中膜厚度(IMT)、收缩期血流峰值流速(Vmax)、舒张期血流峰值流速(Vmin)、有无斑块,计算阻力指数(RI)。根据CKD患者有无糖尿病、粥样斑块分组进行数据分析。结果 CKD4期患者的IMT和斑块检出率高于CKD2-3期患者(P<0.05或P<0.01);CKD5期患者的IMT和斑块检出率高于CKD2-3期(P<0.01)和CKD4期患者(P<0.05),Vmax、Vmin较CKD2-3期患者低(P<0.05)。糖尿病组的年龄、IMT和斑块检出率高于非糖尿病组(P<0.01),Vmax、Vmin降低(P<0.05)。颈动脉斑块阳性组的年龄和IMT较斑块阴性组高(P<0.01),GFR、Vmax、Vmin明显低(P<0.05)。结论 CKD患者随着肾功能的恶化和年龄的增高,动脉粥样硬化逐渐加重,并出现相应的血液动力学改变;糖尿病是动脉粥样硬化加重的重要因素。

Objective To analyze the structure,morphology and hemodynamics of the carotid artery in the patients with chronic kidney disease（CKD）.Methods According to glomerular filtration rate（GFR）,168 CKD patients were devided into three groups of A（CKD2-3,59 cases）,B（CKD4,52 cases） and C（CKD5,57 cases）.The intima media thickness（IMT）,systolic peak velocity（Vmax）,diastolic peak flow velocity（Vmin）,plaque and resistance index（RI） were obtained with color Dopplar ultrasound examination.Then the patients were regrouped according to whether the patients had diabetes and plaque.Results The detection rates of IMT and plaque were in an order of group Cgroup Bgroup A（P0.05 or P0.01）.The Vmax and Vmin were lower in group C than those in group A（P0.05）.The age,IMT and plaque detection rate were higher,but Vmax and Vmin were lower,in diabetic group（24 cases） than those in non-diabetic group（144 cases）（P0.05 or P0.01）.The age and IMT were higher,but GFR,Vmax and Vmin were lower,in plaque-positive group（58 cases） than those in plaque-negative group（110 cases）（P0.05 or P0.01）.ConclusionWith renal function deterioration and increase of age,atherosclerosis of CKD patients is aggravating accompanied by correspondingly hemodynamic changes.Diabetes is an important factor for the aggravation of atherosclerosis.