血液透析患者透析间期颅内动脉血流动力学变化的临床研究

Clinical Investigation of Hemodynamic Variation of Intracranial Arteries in Hemodialysis Patients during Interdialytic Phases

目的探讨血液透析患者透析间期颅内动脉血流动力学动态变化特征。方法本研究采用病例对照研究方法。以经颅多普勒超声（transcranial duplex sonography,TCD）对30例血液透析患者透析间期大脑前动脉（anterior cerebral artery,ACA）、大脑中动脉（middle cerebral artery,MCA）、大脑后动脉（posterior cerebral artery,PCA）以及基底动脉（basilar artery,BA）血流动力学变化进行评估,检测双侧动脉平均流速（mean velocity,MV）、阻力指数（resistant index,RI）及搏动指数（pulsatile index,PI）;以肾功能正常、年龄、性别匹配的28例门诊TCD检查患者为对照组。分析两组间差异并采用Logistic回归方法分析颅内动脉血流动力学改变的相关风险因素。结果血液透析组ACA、MCA、PCA、BA的MV分别为（67.3±12.7）cm/s（P=0.03）、（76.5±13.4）cm/s（P=0.04）、（66.7±12.5）cm/s（P=0.04）及（51.3±10.7）cm/s（P=0.03）,与对照组比较均增加;血液透析组RI、PI与对照组差异无显著性。多因素Logistic回归结果显示,血液透析患者ACA、MCA、PCA、BA的MV增加与贫血相关,其比值比（odds ratio,OR）及95%可信区间（confidence interval,CI）分别为：1.2（1.1-2.9）、2.2（1.8-3.6）、1.9（1.7-3.2）和1.6（1.5-3.1）;上述颅内动脉MV亦与高血压相关,OR值及95%CI分别为：2.4（1.9-3.9）、2.9（1.7-4.2）、2.1（1.7-3.9）和2.6（1.8-3.1）。结论血液透析患者透析间期颅内动脉平均血流速度增加,此改变与贫血及高血压相关。

Objective To investigate hemodynamic variation of intracranial arteries in hemodialysis patients during interdialytic phases. Methods A case-control study was performed with 30 hemodialysis patients and 28 age-gendermatched clinical patients with normal renal function as control group.Both of them received transcranial duplex sonography（TCD） examination,including bilateral mean blood flow velocity（MV） of anterior cerebral artery（ACA）,middle cerebral artery（MCA）,posterior cerebral artery（PCA） and basilar artery（BA）,resistance index（RI）,pulsatility index（PI）.Then Logistic regression analysis was applied to test risk factors of the hemodynamics of intracranial arteries. Results The MV values in ACA,MCA,PCA and BA were（67.3±12.7）cm/s（P=0.03）,（76.5±13.4）cm/s（P=0.04）,（66.7±12.5）cm/s（P=0.04）,（51.3±10.7）cm/s（P=0.03）,respectively,which were significantly increased compared with those in control groups.The Logistic analysis showed that anemia was associated with the increased of MV in each of arteries,the odds ratio（OR） in ACA,MCA,PCA and BA were 1.2（1.1-2.9）,2.2（1.8-3.6）,1.9（1.7-3.2）,1.6（1.5-3.1）,respectively;hypertension was also associated with the increased of MV in all intracranial arteries,the OR（95%CI） were 2.4（1.9-3.9）,2.9（1.7-4.2）,2.1（1.7-3.9）,2.6（1.8-3.1）,respectively. Conclusion The MV of intracranial arteries increases significantly in hemodialysis patients during interdialytic phase,which is associated with anemia and hypertension in these patients.