维持性血液透析患者的动脉粥样硬化

Atherosclerosis occurs in patients undergoing maintenance hemodialysis

背景:动脉粥样硬化是糖尿病肾病及血液透析患者常见的并发症,维持性血液透析时间长短和其他相关因素对糖尿病肾病患者动脉粥样硬化的影响有待于进一步观察及研究。目的:观察不同时间维持性血液透析患者的动脉粥样硬化情况,评价血液透析时间及其他相关因素对糖尿病肾病动脉粥样硬化的影响。方法:利用高频超声检测糖尿病肾病血液透析组、非糖尿病肾病血液透析组、终末期肾病未透析组患者的颈动脉内中膜厚度变化,以健康志愿者作为正常对照组。分析血液透析患者颈动脉内中膜厚度与透析时间的关系,比较各组胰岛素抵抗的变化。结果与结论:与正常对照组相比,糖尿病肾病血液透析组和非糖尿病肾病血液透析组颈动脉内中膜厚度值增大(P<0.01);非糖尿病肾病血液透析24个月组颈动脉内中膜厚度值与非糖尿病肾病未透析组差异无显著性意义(P>0.05);非糖尿病肾病血液透析60个月组颈动脉内中膜厚度值较非糖尿病肾病血液透析24个月组增大(P<0.05);非糖尿病肾病血液透析60个月组颈动脉内中膜厚度值较终末期肾病未透析组明显增大(P<0.01)。糖尿病肾病血液透析60个月组与终末期肾病未透析组及糖尿病肾病血液透析24个月组相比,3组间差异无显著性意义(P>0.05)。糖尿病肾病24个月组HOMA-IR值较糖尿病肾病未透析组稍微降低(P<0.05),糖尿病肾病60个月组HOMA-IR值较糖尿病肾病未透析组显著降低(P<0.01)。提示血液透析在一定程度上可以影响糖尿病肾病维持性血液透析患者动脉粥样硬化的进展,且这种作用与透析时间长短有关。

BACKGROUND： Atherosclerosis is a common complication in diabetic nephropathy and hemodialysis patients. The effect of hemodialysis duration and other relative factors on the atherosclerosis of patients with diabetic nephropathy needs to be further observed and explored. OBJECTIVE： To observe the atherosclerosis in the patients with different hemodialysis durations, then to evaluate the effect of hemodialysis duration and other relative factors on atherosclerosis of patients with diabetic nephropathy. METHODS： The intima-media thickness of the carotid artery in the diabetic nephropathy hemodialysis group, non-diabetic nephropathy hemodialysis group and end-stage renal disease non-hemodialysis group was detected with high-frequency ultrasonic testing, and the healthy volunteers were as the normal control group. The relationship between the intima-media thickness of the carotid artery in the hemodialysis patients and hemodialysis duration was analyzed, and the changes of insulin resistance in each group were compared. RESULTS AND CONCLUSION：Compared with the normal control group, the intima-media thickness of the carotid artery in the diabetic nephropathy hemodialysis group and non-diabetic nephropathy hemodialysis group was increased （P 0.01）; there was no significant difference of intima-media thickness of the carotid artery between 24 hours diabetic nephropathy hemodialysis group and end-stage renal disease non-hemodialysis group （P 0.05）; the intima-media thickness of the carotid artery in the 60 months diabetic nephropathy hemodialysis group was higher than that in the 24 hours diabetic nephropathy hemodialysis group （P 0.05）; the intima-media thickness of the carotid artery in the 60 months diabetic nephropathy hemodialysis group was significantly higher than that in the end-stage renal disease non-hemodialysis group （P 0.01）. There was no significant difference of intima-media thickness of the carotid artery between 60 months diabetic nephropathy hemodialysis group, end-stage renal disease non-hemodialysis group and 24 hours diabetic nephropathy hemodialysis group （P 0.05）. The homeostasis model of assessment-insulin resistance value in the 24 hours diabetic nephropathy hemodialysis group was slightly lower than that in the diabetic nephropathy non-emodialysis group （P 0.05）, and the homeostasis model of assessment-insulin resistance value in the 60 months diabetic nephropathy hemodialysis group was significantly lower than that in the diabetic nephropathy non-emodialysis group （P 0.01）. The development of atherosclerosis on diabetic nephropathy patients can be affected by hemodialysis to some extent. And the effect is correlated with the hemodialysis duration.