超极速脉博波传导速度技术实时定量评估慢性肾病患者颈动脉弹性减退

Ultrafast pulse wave velocity for real-time quantitative evaluation on carotid elasticity decline in patients with chronic kidney disease

目的探讨超极速脉搏波传导速度(ufPWV)技术定量评估慢性肾病(CKD)患者颈动脉弹性减退的临床价值。方法选取91例CKD患者,以估算肾小球滤过率(eGFR)≥60 ml/(min·1.73 m^(2))的1、2期者为早期组(n=44),eGFR<60 ml/(min·1.73 m^(2))的3~5期者为中晚期组(n=47);另选择47例无CKD且肾功能正常者为对照组。采用超声检查双侧颈动脉,并获得颈动脉内-中膜厚度(cIMT),以ufPWV技术检测收缩起始脉搏波传导速度(PWV-BS)及收缩末期脉搏波传导速度(PWV-ES);以双侧颈动脉平均值为最终值进行数据分析。结果早期组PWV-ES较对照组增高(P<0.05);中晚期组cIMT、PWV-ES均较对照组增高(P均<0.05);中晚期组阻力指数(RI)较对照组降低(P<0.05)。cIMT与年龄相关(r=0.216,P=0.011);PWV-BS与高密度脂蛋白相关(r=0.183,P=0.031);PWV-ES与年龄(r=0.496,P<0.001)、收缩压(r=0.338,P<0.001)、舒张压(r=0.264,P=0.002)及空腹血糖(r=0.241,P=0.004)均相关。随年龄增加,3组cIMT均呈上升趋势(P均<0.01),其中早期组cIMT与年龄相关系数最高(r=0.572);PWV-ES亦升高(P均<0.01),早期组PWV-ES与年龄的相关系数最高(r=0.698)。结论ufPWV参数PWV-ES用于评估CKD患者颈动脉粥样硬化风险优于传统指标cIMT,并对评估早期CKD患者肾功能具有潜在价值。

Objective To explore the value of ultrafast pulse wave velocity(ufPWV)technique for quantitatively assessment of carotid artery elasticity decline in patients with chronic kidney disease(CKD).Methods A total of 91 patients with CKD were enrolled.Patients in stage 1 and 2(with estimated glomerular filtration rate[eGFR]≥60 ml/[min·1.73 m^(2)])were divided into early group(n=44),while those in stage 3-5(with eGFR<60 ml/[min·1.73 m^(2)])were divided into middle and late group(n=47),and 47 patients with normal renal function without history of CKD were enrolled in control group.Bilateral carotid artery ultrasound examination and clinical evaluation were performed in all 3 groups.Bilateral carotid arteries were examined with ultrasonography,the carotid intima-media thickness(cIMT)was obtained,pulse wave velocity-beginning of systole(PWV-BS)and pulse wave velocity-end of systole(PWV-ES)were measured with ufPWV technique.The average values of bilateral carotid parameters were taken as the final values,and the data were analyzed.Results PWV-ES in early group was higher than that in control group(P<0.05),cIMT and PWV-ES in middle and late stage group were higher than those in control group(both P<0.05),and the resistance index(RI)in middle and late stage group was lower than that in control group(P<0.05).cIMT was correlated with aging(r=0.216,P=0.011),PWV-BS was correlated with high density lipoprotein(r=0.183,P=0.031),PWV-ES was correlated with aging(r=0.496,P<0.001),systolic blood pressure(r=0.338,P<0.001),diastolic blood pressure(r=0.264,P=0.002)and fasting blood glucose(r=0.241,P=0.004).cIMT increased with aging in all 3 groups(all P<0.01),and the correlation coefficient between cIMT and aging in early group was the highest among 3 groups(r=0.572);PWV-ES increased with aging(all P<0.01),and the correlation coefficient between PWV-ES and aging was the highest in early group(r=0.698).Conclusion As an ufPWV technical index,PWV-ES was superior to traditional index cIMT for evaluating the risk of carotid atherosclerosis in patients with CKD,and had potential value for assessment of renal function in patients with early CKD.