动静脉瘘功能状态对C-反应蛋白的影响及与颈动脉内膜厚度的相关性研究

Study on effec of arteriovenous fistula function status on hs-CRP and its correlation with carotid arterial IMT

目的探讨中年维持性血液透析(MHD)患者的动静脉瘘功能状态对超敏C-反应蛋白(hs-CRP)的影响及与颈动脉内膜-中层厚度(IMT)的相关性。方法收集100例MHD患者,血液透析12个月后,评估动静脉瘘功能,同时检测血液透析前和透析12个月时的hs-CRP水平,并应用彩超检查IMT。结果 (1)100例MHD患者,手术后行动静脉瘘彩超检查,结果显示,血流量200～250 mL/min。血液透析12个月后,有5例患者因血流量小于150 mL/min,在对侧重新造瘘,未纳入分析。本研究中,无血流量大于250 mL/min者。(2)与未血液透析时比较,血液透析后hs-CRP水平显著降低(P<0.05)。(3)透析12个月后,与动静脉瘘功能正常组(n=55)比较,动静脉瘘功能不良组(n=40),hs-CRP水平显著增高(P<0.05)。(4)动静脉瘘功能正常组血液透析前和透析12个月后,IMT比较,未见明显异常(P>0.05);动静脉瘘功能不良组,血液透析前和透析12个月后,IMT比较,差异有统计学意义(P<0.05)。(5)动静脉瘘功能与hs-CRP水平呈负相关(r=-0.547,P<0.01);hs-CRP水平与IMT呈正相关(r=-0.489,P<0.05)。结论监测、维持动静脉瘘的良好功能,对于MHD患者微炎症起着重要作用,可减缓MHD患者动脉粥样硬化的发展。

Objective To discuss the effec of the arteriovenous fistula function status on high sensitive C reactive protein（hs-CRP） in the middle-aged maintenance hemodialysis（MHD） patients and its correlation with carotid artery intima-media thickness（IMT）.Methods 100 cases of middle-aged MHD were collected.After 12-month hemodialysis,the arteriovenous fistula function was evaluated,at the same time the CRP levels were detected before hemodialysis and after 12-month hemodialysis.Color Doppler ultrasound was adopted to dettect IMT.Results（1） The postoperative color Doppler ultrasound examination showed that the blood flow amount was 200-250 mL/min.After 12-month hemodialysis,5 cases were performed the refistulization in the opposite site due to the blood flow amount 150 mL/min and were not included the analysis.In this study,no blood flow amount was greater than 250 mL/min.（2）Compared with non-hemodialysis,the hs-CRP level after hemodialysis was decreased significantly（P0.05）.（3）After 12-months hemodialysis,compared with the normal arteriovenous fistula function group（n=55 cases）,the hs-CRP level in the abnormal arteriovenous fistula dysfunction group（n=40） was significantly increased（P0.05）.（4）IMT before hemodialysis and after 12-month hemodialysis in the normal arteriovenous fistula function group showed no obvious abnormality（P0.05）.But IMT before hemodialysis and after 12-month hemodialysis in the arteriovenous fistula dysfunction group showed statistical diference（P0.05）.（5）The arteriovenous fistula function was negatively correlated with the hs-CRP level（r=-0.547,P0.01）,the hs-CRP level was positively correlated with IMT（r=-0.489,P0.05）.Conclusion Monitoring and maintaining the arteriovenous fistula with good function play an important role for micro inflammation in the MHD patients and can slow down the development of arterial atherosclerosis.