不同超声弹性技术评价慢性肾病患者早期动脉硬化的应用研究

Application of different ultrasonic elastography in evaluating early atherosclerosis in patients with chronic kidney disease

目的探讨实时剪切波弹性成像(SWE)和超极速脉搏波传导速度(ufPWV)技术评价慢性肾病(CKD)患者早期动脉硬化的应用价值。方法选取2019年8月至2022年8月浙江省宁波市第二医院收治的确诊CKD患者135例作为病例组,同期选取肾功能正常的健康人群50例作为对照组,按年龄将病例组和对照组各分为3组(<45岁、45~60岁、>60岁),病例组患者按肾小球滤过率分期分为G1期组、G2期组、G3a期组和G3b期组。应用SWE技术测量各组研究对象颈总动脉前壁平均弹性杨氏模量值(a-MEmean)和后壁平均弹性杨氏模量值(p-MEmean),应用ufPWV技术测量各组研究对象颈总动脉收缩期开始时脉搏波速度(PWV-BS)和收缩期结束时脉搏波速度(PWV-ES),分别得到颈总动脉管壁纵向及环向血管壁硬度。结果病例组患者颈总动脉管壁a-MEmean、p-MEmean、PWV-BS、PWV-ES均明显大于对照组,差异均有统计学意义(P<0.05)。CKD患者颈总动脉管壁a-MEmean、p-MEmean、PWV-BS、PWV-ES均与年龄呈正相关(r=0.352、0.390、0.236、0.218,P<0.05),均与肾小球滤过率呈负相关(r=-0.517、-0.585、-0.515、-0.430,P<0.05)。结论SWE和ufPWV技术均可准确评价CKD患者颈总动脉血管壁早期纵向及环向硬度改变,可为临床诊疗提供有价值的信息。

Objective To explore the application value of real-time shear wave elastography(SWE)and ultrafast pulse wave velocity(ufPWV)in evaluating early atherosclerosis in patients with chronic kidney disease(CKD).Methods A total of 135 patients with CKD diagnosed in Ningbo Second Hospital from August 2019 to August 2022 were selected as the case group,and 50 healthy people with normal renal function were selected as the control group.The case group and the control group were divided into three groups according to age(<45 years old,45-60 years old,>60 years old).The patients in the case group were divided into G1 stage group,G2 stage group,G3a stage group,and G3b stage group according to the glomerular filtration rate.The mean elastic Young′s modulus(a-MEmean)of the anterior wall and the mean elastic Young′s modulus(p-MEmean)of the posterior wall of the common carotid artery were measured by SWE technique.The pulse wave velocity(PWV-BS)at the beginning of the systolic period and the pulse wave velocity(PWV-ES)at the end of the systolic period of the common carotid artery were measured by ufPWV technique.Results The a-MEmean,p-MEmean,PWV-BS and PWV-ES of the common carotid artery wall in the case group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).The a-MEmean,p-MEmean,PWV-BS and PWV-ES of carotid artery wall in CKD were positively correlated with age(r=0.352,0.390,0.236,0.218,P<0.05),and negatively correlated with glomerular filtration rate(r=-0.517,-0.585,-0.515,-0.430,P<0.05).Conclusion Both SWE and ufPWV can accurately evaluate the early longitudinal and circumferential stiffness changes of carotid artery vessel wall in CKD patients,which can provide valuable information for clinical diagnosis and treatment.