高频超声评价血液透析患者血管内皮舒张功能

Vascular endothelial function of brachial and popliteal arteries in hemodialysis patients by high resolution ultrasound examination

目的以高频超声探求糖尿病肾病、非糖尿病肾病患者在透析前及不同透析时间段的肱动脉、腘动脉内皮功能指标,评价糖尿病肾病血液透析患者的上、下肢血管内皮功能及随透析时间的变化规律。方法据原发病选择糖尿病肾病(DKD)与非糖尿病(NDKD)患者作为受试者,并分别据透析年限分为透析前组(-preHD),透析12月组(-12),透析36月组(-36),每组20例,正常对照(NC)组20例。利用高频彩色多普勒超声,测量肱动脉扩张系数(DC),僵硬度(SD),肱动脉及腘动脉血管基础状态及加压后血管内径,并计算血流介导的扩张值(FMD)。结果 1肱动脉FMD(%)、腘动脉FMD(%)、肱动脉DC值,NC组、DKDpreHD组、DKD-12组、DKD-36组相比逐渐减低,肱动脉SD值、肱/腘动脉FMD差值(%)逐渐增加,DKD-36组较其他各组差异显著(P<0.05);2肱动脉FMD(%)、腘动脉FMD(%)、肱动脉DC值,NDKD-preHD组、NDKD-12组、NDKD-36组相比逐渐减低,肱动脉SD值逐渐增加、肱/腘动脉FMD差值(%),NDKD-36组较其他各组差异显著(P<0.05);3各组受试者,腘动脉FMD(%)明显低于肱动脉FMD(%),差异显著(P<0.05);4组间比较提示,DKD患者肱动脉DC值,肱、腘动脉FMD(%)值小于NDKD组,SD值大于NDKD组,差异显著(P<0.05)。结论糖尿病肾病血液透析患者肱动脉内皮功能损害程度较其他原发病患者更为严重,且随透析年限延长继续恶化;随着透析年限的延长,糖尿病肾病及非糖尿病肾病患者的腘动脉血管内皮舒张功能障碍均较肱动脉进展快,且糖尿病肾病组进展更快。

Objective To find out the changes of peripheral arteries in hemodialysis patients with kidney failure caused by diabetes,we studied the endothelial function of brachial and popliteal arteries by using high resolution ultrasound examination.Methods Distensibility coefficient （DC）,stiffness degree （SD） and flow-mediated dilatation （FMD） were calculated from the results of high resolution ultrasound examination in patients with kidney failure due to diabetes （DKD,n=60） and due to other diseases （NDKD,n=60）.They were subdivided by hemodialysis age into pre-HD subgroup （before hemodialysis,n=20）,12 months subgroup （hemodialysis for 12 months,n=20）,and 36 months subgroup （hemodialysis for 36 months,n=20）.Twenty healthy volunteers were also included as control group （NC）.Results ① The values of DC and FMD of brachial artery and FMD of popliteal artery decreased gradually,the values of SD of brachial artery and the difference between FMD levels from brachial and popliteal arteries increased gradually in the order of NC group,the pre-HD,12 months,and 36 months subgroups of DKD group.These changes were statistically significant in the 36 months subgroup of DKD group as compared with those in the other subgroups of DKD group （P＜0.05）.② In the subgroups of NDKD group,the changes ofDC,FMD and SD in brachial and popliteal arteries were similar to those found in the subgroups of DKD group.③ FMD level was significantly lower in popliteal artery than that in brachial artery in all of the groups we studied （P＜0.05）.④ DC in brachial artery and the difference between FMD levels from brachial and popliteal arteries were lower and SD was higher in DKD group than those in NDKD group （P＜0.05）.Conclusion The injury of endothelial function in brachial artery is more serious in hemodialysis patients due to diabetes than in those due to other diseases.With the increase of dialysis age vascular endothelial injury deteriorates in hemodialysis patients due to diabetes,and the dysfunction of vascular dilatation progresses faster in popliteal artery than in brachial artery in hemodialysis patients especially in those due to diabetes.