高频彩超判断1年以上血液透析患者动脉内皮舒张功能及内-中膜厚度的临床价值

Clinical significance of high frequency color doppler ultrasonography in patients with hemodialysis

目的研究高频彩色超声在判断1年以上血液透析患者内皮舒张功能(EDD)和肱动脉内-中膜厚度(IMT)的临床价值。方法纳入90例接受维持性血液透析患者作为观察组,根据透析时间分为观察A组(透析时间超过1年)和观察B组(透析时间未超过1年),另纳入60例体检健康者为对照组。所有患者均接受高频彩色超声检查,检测肱动脉IMT,计算肱动脉EDD,分析IMT与EDD的关系,记录血液透析患者3年生存情况。结果观察A组48例,观察B组42例,3组间EDD和IMT水平差异有统计学意义(P<0.05),其中观察A组EDD低于观察B组和对照组(P<0.05),而IMT高于观察B组和对照组(P<0.05),直线线性回归分析显示研究对象EDD与IMT呈负相关(r=-0.782)。观察A组死亡15例,3年中位生存时间(29.65±1.44)个月,无事件生存17例,中位时间(26.83±1.57)个月。观察B组死亡12例,3年中位生存时间(33.14±0.82)个月,无事件生存24例,中位时间(32.19±0.94)个月。两组患者总生存率差异无统计学意义(χ~2=1.936,P=0.164),观察B组无事件生存率高于观察A组(χ~2=5.987,P=0.014)。经受试者工作曲线(ROC)分析显示,观察A组EDD和IMT预测不良预后的曲线下面积(AUC)分别为0.881和0.818(95%Cl:0.788,0.975;0.699,0.936),最佳截断值分别为6.43%和0.99 mm,敏感性分别为0.889和0.900,特异性分别为0.733和0.611。观察B组EDD和IMT预测不良预后的AUC分别为0.654和0.632(95%Cl:0.489,0.819;0.459,0.805),最佳截断值分别为10.33%和1.01 mm,敏感性分别为0.458和0.500,特异性分别为0.889和0.722。结论高频彩超检测用于持续性血液透析患者能准确反映肱动脉内皮舒张功能,通过高频彩超监测1年以上血液透析患者肱动脉EDD和IMT水平对判断预后具有较高指导价值。

Objective To study the clinical significance of and（EDD）and intima media thickness（IMT）determined by high frequency color doppler doppler ultrasonography in patients with hemodialysis over 1 year.Methods A total of 90 patients receiving hemodialysis were included in the observation group.The patients in group A underwent dialysis over 1 year（n=48）,and patients in group B received dialysis less than 1 year（n=42）.Sixty healthy subjects were enrolled as control group.IMT and the EDD determined by high-frequency color Doppler ultrasonography in all individuals were recorded.3 year survival were recorded.Results EDD decreased while IMT increased significantly in group A when compared with group B and control group（P〈0.05）.The linear regression analysis showed negative correlation between EDD and IMT（r=-0.782）.Totally 15 cases died in group A with the median survival time of（29.65±1.44）months in 3 years,and 17 patients had no event survival with the median time of（26.83±1.57）months.Twelve cases died in group B with the median survival time of（33.14±0.82）months in 3years,and 24 patients had no event survival with the median time of（32.19±0.94）months.No significant difference in total survival rate was founded between two groups（χ~2=1.936,P=0.164）,while patients in group B experienced higher rate of event free survival when compared with group A（χ~2=5.987,P=0.014）.The ROC analysis showed that the AUC of EDD and IMT for prediction of poor prognosis in group A was 0.881 and 0.818,respectively（95%Cl：0.788,0.975,0.699 and 0.936,respectively）.The best cut-off value for EDD and IMT were 6.43%and 0.99 mm,respectively.Sensitivities for EDD and IMT were 0.889 and 0.900,respectively.The specificity for EDD and IMT were0.733 and 0.611,respectively.The AUC of EDD and IMT in group B for prediction of poor prognosis were 0.654 and0.632,respectively（95%Cl：0.489,0.819,0.459 and 0.805）.The best cut-off values for EDD and IMT were 10.33%and 1.01 mm,respectively.The sensitivities of EDD and IMT were 0.458 and 0.500,respectively.The specificity of EDD and IMT were 0.889 and 0.722,respectively.Conclusion The high frequency color doppler ultrasonography can accurately reflect endothelium-dependent relaxation of brachial artery in patients undergoing continuous hemodialysis.EDD and IMT may be the reliable prognostic parameters.