强化调脂治疗对维持性血液透析患者动脉粥样硬化的影响

The effects of enhanced blood lipid regulating therapy on atherosclerosis in maintenance hemodialysis patients

目的探讨强化调脂治疗对维持性血液透析（maintenance hemodialysis,MHD）患者动脉粥样硬化的影响。方法选择2009年1月~12月在兰州大学第二医院肾内院血液透析中心进行MHD的患者63例,随机分为2组,治疗组36例,给予调脂治疗,对照组27例,不予降脂治疗,共随访3年。在随访第1、2、和3年检测收集血脂、采用IU22彩色多普勒超声诊断仪检测（3-9MHZ探头）颈动脉内-中膜厚度（intima-medial thickness,IMT）、粥样硬化斑块、收缩期峰值流速（peak systolic velocity,PSV）和舒张末期流速（end diastolic velocity,EDV）,并计算粥样硬化斑块阳性率和颈动脉狭窄发生率。结果在随访的3年中,对照组第1、2、3年颈动脉平均IMT均增加（0.95±0.91mm vs 1.37±0.89mm,P〈0.05;0.95±0.91mm vs 1.41±0.93mm,P〈0.05;0.95±0.91mm vs 1.57±0.99mm,P〈0.01）,治疗组第1、2年无明显变化,第3年有所增加（0.97±0.87mm vs 1.36±0.55mm,P〈0.01）。治疗组斑块阳性率明显低于对照组（P〈0.01）,狭窄发生率也明显低于对照组（P〈0.05）。结论强化降脂治疗可以延缓MHD患者颈动脉平均IMT,减少斑块形成和动脉狭窄。

Objective To evaluate the effects of enhanced blood lipid regulating therapy on atherosclerosis in maintenance hemodialysis（MHD） patients.Methods Sixty-three MHD patients treated in our dialysis center during the period from Jan.1,2009 to Jan.30,2010 were recruited in this study.Patients were divided into control group（n=27） or treatment group（n=36）.Patients in the treatment group were given lipid regulating drugs for 3 years.Color Doppler ultrasonography（IU22,3-9 MHZ） was performed for the examination of carotid arteries including intima-medial thickness（IMT） and atherosclerotic plaques.Total cholesterol（TC）,triglyceride（TG）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C） were determined as well.Results During the 3 years of follow-up period,average IMT in control group increased significantly（0.95 ± 0.91mm vs.1.37 ± 0.89mm after one year,P0.05;0.95 ± 0.91mm vs.1.41 ± 0.93mm after 2 years,P0.05;0.95±0.91mm vs.1.57±0.99mm after 3 years,P0.01）,and average IMT in treatment group remained unchanged after the treatment for one and two years,but increased（0.97±0.87mm vs.1.36±0.55mm,P0.01） after the treatment for 3 years.The prevalence rates of atherosclerotic plaque and carotid artery stenosis were significantly lower in treatment group than in control group（P0.01 and 0.05,respectively）.Conclusion Enhanced lipid regulating therapy reduces the level of IMT,lowers the prevalence rates of atherosclerotic plaque and carotid artery stenos in MHD patients.