维持性血液透析患者致颈动脉粥样硬化相关影响因素分析

Analysis of related influencing factors of carotid atherosclerosis in maintenance hemodialysis patients

目的探讨终末期肾脏疾病(ESRD)患者维持性血液透析(MHD)致颈动脉粥样硬化相关影响因素。方法回顾性分析2019年1月至2022年2月该院收治的98例行MHD的ESRD患者资料。收集病史资料,如年龄、性别、吸烟史、高血压病史和糖尿病病史,评估血生化指标,包括血尿素氮(BUN)、血肌酐(Scr)、血红蛋白、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、高敏C反应蛋白(hs-CRP)和白蛋白。所有患者均进行颈动脉彩色多普勒超声检查,按颈动脉斑块有无分为颈动脉粥样硬化组(硬化组)和颈动脉血管正常组(对照组)。采用彩色多普勒测量患者双侧颈动脉内-中膜厚度(CIMT)、收缩期峰值流速(PSV),舒张末期流速(EDV),搏动指数(PI),阻力指数(RI)。结果98例患者中硬化组72例(73.5%),对照组26例(26.5%)。与对照组比较,硬化组TG[(2.55±1.26)mmol/L vs.(1.87±1.24)mmol/L]、LDL-C[(2.94±0.57)mmol/L vs.(2.58±1.21)mmol/L]、hs-CRP[(12.86±3.82)g/L vs.(7.02±1.09)g/L]水平更高,HDL-C[(2.14±0.75)mmol/L vs.(2.67±0.34)mmol/L]、白蛋白[(35.14±6.90)mg/L vs.(47.54±5.30)mg/L]水平更低,差异有统计学意义(P<0.05)。与对照组比较,硬化组CIMT[(2.19±0.63)mm vs.(0.74±0.14)mm]更厚,PSV[(40.34±6.58)cm/s vs.(55.23±12.35)cm/s]、EDV[(8.29±4.17)cm/s vs.(18.67±8.64)cm/s]更慢,PI[(1.48±0.73)vs.(0.85±0.08)]、RI[(0.81±0.17)vs.(0.65±0.21)]更高,差异有统计学意义(P<0.05)。相关性分析结果显示,硬化组CIMT与hs-CRP呈正相关(r=0.811),CIMT与白蛋白呈负相关(r=—0.864),hs-CRP与白蛋白呈负相关(r=—0.756)。结论高hs-CRP及低白蛋白水平可以准确预测行MHD的ESRD患者颈动脉粥样硬化情况。

Objective To investigate the related factors of carotid atherosclerosis induced by maintenance hemodialysis(MHD)in patients with end-stage renal disease(ESRD).Methods Clinical data of 98 ESRD patients with MHD admitted to the hospital from January 2019 to February 2022 were retrospectively analyzed.Medical history data,such as age,gender,smoking history,hypertension history and diabetes history were collected,while blood biochemical indexes were evaluated,which including blood urea nitrogen(BUN),serum creatinine(Scr),hemoglobin,total cholesterol(TC),triglycerides(TG),high density lipoprotein-cholesterol(HDL-C),low density lipoprotein-cholesterol(LDL-C),high sensitive-C reactive protein(hs-CRP),and albumin.All patients underwent carotid color ultrasound doppler examination and were divided into the carotid atherosclerosis group(the sclerotic group)and the carotid vascular normal group(the control group)according to the presence of carotid plaque.The carotid intima media thickness(CIMT),peak systolic velocity(PSV),end-diastolic velocity(EDV),pulsation index(PI),and resistance index(RI)were measured by color doppler.Results Among the 98 patients,72 cases(73.5%)were in the sclerotic group and 26 cases(26.5%)were in the control group.Compared with the control group,The levels of TG[(2.55±1.26)mmol/L vs.(1.87±1.24)mmol/L],LDL-C[(2.94±0.57)mmol/L vs.(2.58±1.21)mmol/L],hs-CRP[(12.86±3.82)g/L vs.(7.02±1.09)g/L]in the sclerosis group were higher,while the levels of HDL-C[(2.14±0.75)mmol/L vs.(2.67±0.34)mmol/L]and albumin[(35.14±6.90)mg/L vs.(47.54±5.30)mg/L]were lower,the difference was statistically significant(P<0.05).Compared with the control group,in the sclerosis group,CIMT[(2.19±0.63)mm vs.(0.74±0.14)mm]was thicker,PSV[(40.34±6.58)cm/s vs.(55.23±12.35)cm/s],EDV[(8.29±4.17)cm/s vs.(18.67±8.64)cm/s]were slower,PI[(1.48±0.73)vs.(0.85±0.08)]and RI[(0.81±0.17)vs.(0.65±0.21)]were higher,the difference was statistically significant(P<0.05).Correlation analysis showed that,CIMT was positively correlated with hs-CRP(r=0.811),CIMT was negatively correlated with albumin(r=—0.864),and hs-CRP was negatively correlated with albumin(r=-0.756).Conclusion High hs-CRP and low albumin levels can accurately predict carotid atherosclerosis in ESRD patients undergoing MHD.