高频超声评价血红蛋白变异血液透析患者颈动脉内中膜厚度的临床价值

Correlation between hemoglobin variability and carotid intima-media thickness in hemodialysis patients evaluated by using high frequency ultrasound

目的 利用高频超声探讨Hb变异的血液透析患者与颈动脉内中膜厚度(CIMT)之间的可能关系。方法 对66例的维持性血液透析(透析时间≥12个月)患者的Hb值进行回顾性分析。 根据KDOQI指南,Hb正常目标值为110~112 g/L,Hb<110 g/L为低水平,Hb> 120 g/L为高水平。根据患者近12个月的血红蛋白轨迹将其分为3组:LAL组(Hb值围绕目标范围下限波动);LAH组(Hb值围绕目标范围上限波动);HA组(高波动组)。对双侧颈总动脉进行内中膜厚度的测量。根据CIMT测量、患者一般资料和实验室指标对3组患者进行比较分析。结果 LAL,LAH和HA组在年龄、性别、糖尿病发病率、高血压和心血管疾病方面相似。血液透析持续时间,血液透析充分性,血清脂质和CaxP在各组之间也相似。LAL,HA和LAH组的平均CIMT值分别为(0.602±0.108)mm,(0.743±0.140)mm和(0.603±0.135)mm。HA组的CIMT明显高于其他2组,差异有统计学意义(P<0.05)。结论 当检查具有相似的动脉粥样硬化危险因素的3组患者时,具有最高血红蛋白变异性的HA组具有最高的CIMT。本研究旨在证明Hb变异性与血液透析患者CIMT的增加有关,高频超声可以便捷的、快速的检查出血液透析患者CIMT。

Objective To investigate the possible correlation between hemoglobin (Hb) variability and carotid intima-media thickness (CIMT) in hemodialysis patients evaluated by using high frequency ultrasound.Methods The Hb values of 66 patients with maintenance hemodialysis (dialysis time ≥ 12 months) were retrospectively analyzed.According to the KDOQI guidelines,the normal target value of Hb was 110~112g/L,and Hb<110g/L was low level,and Hb>120g/L was high level.According to the hemoglobin trajectory of the patient in the past 12 months,they were divided into three groups: LAL group (Hb value fluctuated around the lower limit of the target range);LAH group (Hb value fluctuated around the upper limit of the target range);HA group (high fluctuation group).The intima thickness of bilateral common carotid arteries was measured. The CIMT measurement results,general data and laboratory indexes were observed and compared among the three groups.Results The patient’s age and gender,diabetes incidence rate,hypertension and cardiovascular disease were similar among LAL group ,LAH group and HA groups,moreover, the hemodialysis duration,hemodialysis adequacy,serum levels of lipids and CaxP were similar among the three groups.The mean CIMT values in LAL group,HA group,and LAH groups were (0.599±0.109)mm,(0.745±0.138)mm,(0.603±0.135)mm,respectively.The CIMT value in HA group was significantly higher than that in the other two groups (P<0.05).Conclusion The patients with the highest hemoglobin variability have the highest CIMT values.The Hb variability may be correlated with the increase of CIMT in hemodialysis patients.High-frequency ultrasound can easily and quickly check out CIMT in hemodialysis patients.