超极速脉搏波技术在肾功能异常患者颈动脉弹性衰退定量评估中的应用价值

Application value of ultrafast ultrasound imaging pulse wave velocity technology on the evaluation of carotid artery elasticity decline in patients with renal insufficiency

目的:探讨超极速脉搏波(ufPWV)技术在肾功能异常患者颈动脉弹性衰退定量评估中的应用价值。方法:纳入我院体检及住院患者共495例,采集患者的性别、年龄、身高、体重、收缩压、舒张压以及血甘油三酯、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、总胆固醇、葡萄糖、肌酐、尿素、尿酸等数据,并根据公式计算出体重指数(BMI)及预估肾小球滤过率(eGFR),测量颈总动脉内中膜厚度(cIMT),并利用ufPWV技术测量颈总动脉收缩早期脉搏波传导速度(PWV-BS)和收缩末期脉搏波传导速度(PWV-ES)。依据eGFR将患者分为两组:肾功能异常组90例,肾功能正常组405例。对上述资料进行统计学分析。结果:(1)与肾功能正常组相比,肾功能异常组PWV-ES和cIMT均显著增高[(9.52±2.01)m·s^(-1)vs.(8.45±2.15)m·s^(-1),(0.059±0.011)cm vs.(0.056±0.012)cm],差异均有统计学意义(均P<0.05),而PWV-BS差异无统计学意义(P>0.05)。(2)Pearson相关分析显示,肾功能正常组cIMT、PWV-BS、PWV-ES均与年龄呈正相关(r值分别为0.618、0.310、0.657,均P<0.05),与eGFR呈负相关(r值分别为0.379、0.159、0.413,均P<0.05);肾功能异常组cIMT、PWV-ES均与年龄呈正相关(r值分别为0.350、0.400,均P<0.05),cIMT与eGFR呈负相关(r值为0.248,P<0.05),而PWV-BS与年龄、eGFR无明显相关性,PWV-ES与eGFR亦无明显相关性(均P>0.05)。(3)二元Logistic逐步回归分析显示,PWV-ES是独立于性别、尿素、尿酸、LDL的肾损伤潜在影响因素(OR=1.262,P<0.05),但具有年龄依赖性。结论:ufPWV技术可定量评价肾功能异常患者颈动脉弹性的变化,PWV-ES增高是肾损伤的潜在危险因素,可作为肾损伤的综合诊断指标。

Objective:To explore the application value of ultrafast pulse wave velocity(ufPWV)technology on the evaluation of carotid artery elasticity decline in patients with renal insufficiency.Methods:A total of 495 cases of health screen/checkups and inpatient in our hospital were included.The genereal information include gender,age,body mass index(BMI),systolic blood pressure,diastolic blood pressure,and biochemical indexes such as triglyceride(TG),low density lipoprotein(LDL),high density lipoprotein(HDL),total cholesterol(TC),fasting blood glucose(GlU),serum creatinine(Scr),urea(UREA),uric acid(UA)were collected.eGFR was calculated according to the formula,the intima-media thickness(cIMT)of common carotid artery was measured,and the PWV-BS and PWV-ES of common carotid artery were measured by ufPWV technique.According to eGFR,the subjects were divided into two groups:abnormal renal function group(n=90)and normal renal function group(n=405).The above data were statistically analyzed.Results:(1)The differences of PWV-ES and cIMT between the two groups were statistically significant(all P<0.05),but there was no significant difference in PWV-BS(P>0.05).(2)Correlation analysis showed that cIMT,PWV-BS and PWV-ES were positively correlated with age in normal renal function group(r=0.618,0.310,0.657,all P<0.05),and negatively correlated with eGFR(r=0.379,0.159,0.413,all P<0.05);cIMT and PWV-ES were positively correlated with age in abnormal renal function group(r=0.350,0.400,all P<0.05),cIMT was negatively correlated with eGFR(r=0.248,P<0.05),while PWV-BS was not significantly correlated with age and eGFR,and PWV-ES was not significantly correlated with eGFR(all P>0.05).(3)Logistic regression analysis showed that PWV-ES was independent of gender,urea,UA and LDL(OR=1.262,P<0.05),but not independent of age.Conclusion:The ufPWV technique can quantitatively evaluate carotid artery elasticity decline in patients with renal insufficiency,and the increase of PWV-ES is a potential risk factor for renal insufficiency,which can be used as a comprehensive diagnostic index for renal injury.