老年慢性肾衰病人颈动脉内-中膜厚度的变化及其相关因素研究

CAROTID ARTERIAL INTIMA-MEDIA THICKNESS AND RISK FACTORS IN ELDERLY CHRONIC RENAL FAILURE PATIENTS

研究老年慢性肾衰病人颈动脉粥样硬化引起的内 中膜厚度 (IMT)变化情况及其主要危险因素。对 30例老年慢性肾衰尿毒症病人 (其中 16例为血液透析病人 )进行研究 ,以年龄性别相当的 31名健康老年人作对照。测量血压 ,采血检测甘油三酯、胆固醇、尿素氮、肌酐、血红蛋白。用彩色多普勒超声测量老年慢性肾衰病人左右颈动脉的IMT厚度、内径、血流与血管阻力 ;心脏超声测量左室后壁厚度、室间隔厚度、升主动脉宽度与射血分数 (EF) ,同时对结果进行相关研究 ,并对影响颈动脉IMT的多因素进行逐步回归分析。结果显示 ,本组老年慢性肾衰病人的颈动脉IMT增厚的发生率是 5 6 6 % (17例) ,透析病人的发生率是 75 % (12例 ) ;2 0 %病人 (6例 )至少存在1个粥样斑块。颈左动脉的内径大小、内膜厚度以及血管阻力与右颈动脉之间存在明显的相关关系。肾功能不全的程度、血胆固醇的水平、动脉收缩压以及心脏EF与IMT的关系密切相关。多因素逐步回归分析发现 ,血清肌酐与血胆固醇的增高是导致颈动脉IMT增厚的独立危险因素。在老年慢性肾衰病人中 ,颈动脉IMT增厚的情况十分常见。高龄、高血压、肾功能不全的程度及血脂代谢异常与颈动脉IMT增厚的发生密切相关 ,其中血清肌酐与血胆固醇是独立危险因素。这些可能是导致老年慢性?

To measure carotid intima media thickness(IMT) and to investigate the relationship between carotid atherosclerosis and some major risk factors in elder uremic patients, a cross sectional study was carried out in 30unselected elder uremic patients (16on hemodialysis). Fasting blood sampling for serum lipids, BUN, creatinine, hemoglobin, and echo colour Doppler evaluation of common carotid arteries and heart were performed , BP was measured in all patients (before dialysis day in hemodialysis patients). Relationship between the results and miltifactoral regression analysis were also carried out. 17 patients(56 6%)had carotid IMTwhile 12 dialysis patients(75%) had it. 6patients (20%) had at least one plaque. A significant correlation was found in internal diameter of carotid arteries, IMT and blood vessel resistance between left and right carotid arteries. Carotid IMT had a close relationship with serum BUN, creatinine, cholesterol, systolic BP and heart ejection fraction. In multiple regression models, serum creatinine and cholesterol was significant and an independent predictor of the degree of carotid IMT. In elder uremic patients, carotid IMT is quite common. Elder age, hypertension, degree of renal insufficiency and dyslipidemia are associated with carotid atherosclerosis. Serum creatinine and cholesterol appears to serve as an independent predictor of carotid atherosclerosis, which contributes to the cardiovascular complications and high mortality in elder uremic patients.