颈动脉多普勒超声对慢性肾病患者动脉粥样硬化程度及血流动力学的诊断价值
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摘要
目的:研究颈动脉多普勒超声对慢性肾病患者动脉粥样硬化程度及血流动力学的诊断价值。方法:随机选取长沙市第一医院收治的慢性肾病患者80例为研究对象,其中包括40例血液透析患者,40例腹膜透析患者,并同期选取健康体检者40例作为对照组,对比分析各组颈动脉多普勒超声检查结果。结果:血液透析组和腹膜透析组患者的内中膜厚度、颈总及颈内动脉峰值血流速度、颈总及颈内动脉舒张末血流速度均明显高于对照组(P<0.05),且血液透析组内中膜厚度与腹膜透析组比较差异并不显著(P>0.05);但是血液透析组颈总及颈内动脉峰值血流速度及动脉舒张末血流速度均明显低于腹膜透析组(P<0.05)。结论:颈动脉多普勒超声能够有效测量慢性肾病患者颈总及颈内动脉峰值血流速度、舒张末血流速度及内中膜厚度,对防治患者出现心脑血管事件具有积极作用。
Objective To explore the value of carotid Doppler ultrasound in the diagnosis of atherosclerosis and hemodynamic status in patients with chronic renal diseases. Methods Eighty patients with chronic kidney diseases in the First Hospital of Changsha, including 40 patients receiving hemodialysis and 40 patients receiving peritoneal dialysis, were enrolled in this study.Meanwhile, 40 healthy subjects were selected as control group. The results obtained with carotid Doppler ultrasound in different groups were compared. Results The intima-media thickness, the peak blood flow velocities in common carotid artery and internal carotid artery, the end-diastolic blood flow velocities in common carotid artery and internal carotid artery in hemodialysis group and peritoneal dialysis group were higher than those in control group(P<0.05), and no significant differences were found in intimamedia thickness between hemodialysis group and peritoneal dialysis group(P>0.05). However, the blood velocities in common carotid artery and internal carotid artery in hemodialysis group were significantly lower than those in peritoneal dialysis group(P<0.05). Conclusion Carotid Doppler ultrasound can effectively measure intima-media thickness, and the peak blood flow velocities and end-diastolic blood flow velocities in common carotid artery and internal carotid artery in patients with chronic kidney diseases, which is helpful for the prevention and treatment of cerebrovascular diseases in patients with chronic kidney diseases.
Objective To explore the value of carotid Doppler ultrasound in the diagnosis of atherosclerosis and hemodynamic status in patients with chronic renal diseases. Methods Eighty patients with chronic kidney diseases in the First Hospital of Changsha, including 40 patients receiving hemodialysis and 40 patients receiving peritoneal dialysis, were enrolled in this study.Meanwhile, 40 healthy subjects were selected as control group. The results obtained with carotid Doppler ultrasound in different groups were compared. Results The intima-media thickness, the peak blood flow velocities in common carotid artery and internal carotid artery, the end-diastolic blood flow velocities in common carotid artery and internal carotid artery in hemodialysis group and peritoneal dialysis group were higher than those in control group(P<0.05), and no significant differences were found in intimamedia thickness between hemodialysis group and peritoneal dialysis group(P>0.05). However, the blood velocities in common carotid artery and internal carotid artery in hemodialysis group were significantly lower than those in peritoneal dialysis group(P<0.05). Conclusion Carotid Doppler ultrasound can effectively measure intima-media thickness, and the peak blood flow velocities and end-diastolic blood flow velocities in common carotid artery and internal carotid artery in patients with chronic kidney diseases, which is helpful for the prevention and treatment of cerebrovascular diseases in patients with chronic kidney diseases.
引文
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[8]杨克,张云山,刘秋颖,等.血液透析患者动脉粥样硬化的高频超声评价[J].海军医学杂志, 2013, 34(5):324-327.YANG K, ZHANG Y S, LIU Q Y, et al. High frequency ultrasound evaluation of atherosclerosis in hemodialysis patients[J]. Journal of Navy Medicine, 2013, 34(5):324-327.
[9]任永凤,王洲,李健,等.慢性肾病患者颈动脉多普勒超声应用及临床价值[J].蚌埠医学院学报, 2015, 40(4):513-516.REN Y F, WANG Z, LI J, et al. Application and clinical value of carotid Doppler ultrasound in patients with chronic kidney disease[J]. Journal of Bengbu Medical College, 2015, 40(4):513-516.
[10]SVENNINGSEN P, ANDERSEN H, NIELSEN L H, et al. Urinary serine proteases and activation of ENaC in kidney-implications for physiological renal salt handling and hypertensive disorders with albuminuria[J]. Pfluegers Arch, 2015, 467(3):531-542.
[11]段丽英,贾蓉.彩色多普勒超声在评估颈动脉粥样硬化斑块与脑梗死相关性中的应用价值研究[J].山西医药杂志, 2016, 45(15):1765-1767.DUAN L Y, JIA R. Application of color Doppler ultrasound in assessing the correlation between carotid atherosclerotic plaque and cerebral infarction[J]. Shanxi Medical Journal, 2016, 45(15):1765-1767.
[12]吴苑华,胡萍香,朱彤,等.超声弹性成像声触诊组织定量分析技术在慢性肾病中的应用价值[J].中国医学装备, 2016, 13(12):59-62.WU Y H, HU P X, ZHU T, et al. Application value of ultrasound elastography acoustic palpation tissue quantitative analysis technique in chronic kidney disease[J]. Chinese Medical Equipment, 2016, 13(12):59-62.
[13]SALK I, YILDIZ G, EGILMEZ H, et al. Carotid artery Doppler ultrasonography in patients with chronic kidney disease[J]. Med Sci Monit, 2014, 7(20):11-18.
[14]YU F P, ZHAO Y C, GU B, et al. Chronic kidney disease and carotid atherosclerosis in patients with acute stroke[J]. Neurologist, 2015, 20(2):23-29.
[15]HAKIMI S S, SABERI H, ROKNIYAZDI H, et al. Carotid artery stenosis in patients with chronic kidney disease undergoing dialysis:epidemiological aspects, main risk factors and appropriate diagnostic criteria[J]. Saudi J Kidney Dis Transpl, 2014, 25(1):58-65.
[16]AO D H, ZHAI F F, HAN F, et al. Large vessel disease modifies the relationship between kidney injury and cerebral small vessel disease[J]. Front Neurol, 2018, 26(9):498.
[17]赵蕊,吴玉林,安琳,等.超声诊断在老年慢性肾病中的应用价值研究[J].中国全科医学, 2012, 15(19):2181-2183.ZHAO R, WU Y L, AN L, et al. Application value of ultrasound diagnosis in elderly patients with chronic kidney disease[J]. Chinese Journal of General Practice, 2012, 15(19):2181-2183.
[2] LENOIR O, JASIEK M, HéNIQUE C, et al. Endothelial cell and podocyte autophagy synergistically protect from diabetes-induced glomerulosclerosis[J]. Autophagy, 2015, 11(7):1130-1145.
[3]许立岩,张新书,姜凡,等. RT-3DE技术评估早期慢性肾病患者左心室收缩同步性[J].中国超声医学杂志, 2017, 33(2):125-128.XU L Y, ZHANG X S, JIANG F, et al. Evaluation of left ventricular systolic synchrony in patients with early chronic kidney disease by RT-3DE technique[J]. Chinese Journal of Ultrasound in Medicine, 2017,33(2):125-128.
[4]刘飞,徐东,张科峰,等.颈动脉狭窄程度对冠脉搭桥术中大脑动脉血流变化的影响[J].热带医学杂志, 2016, 16(4):474-476.LIU F, XU D, ZHANG K F, et al. Effects of carotid stenosis on cerebral arterial blood flow changes during coronary artery bypass grafting[J]. Journal of Tropical Medicine, 2016, 16(4):474-476.
[5]王应,刘从国,程蓉,等.糖尿病肾病患者血液透析中血压变化特点及护理措施探析[J].海军医学杂志, 2015, 7(4):334-336.WANG Y, LIU C G, CHENG R, et al. Characteristics of blood pressure changes and nursing measures in hemodialysis patients with diabetic nephropathy[J]. Journal of Navy Medicine, 2015, 7(4):334-336.
[6]孔维敏,刘林,薛存屹,等.颈动脉内中膜增厚及斑块对中风和冠心病事件的影响[J].中国热带医学, 2016, 16(1):76-79.KONG W M, LIU L, XUE C Y, et al. Effects of carotid intima-media thickening and plaque on stroke and coronary heart disease events[J].China Tropical Medicine, 2016, 16(1):76-79.
[7]高亚军,屈永才,薛艺东.颈动脉粥样硬化及血流动力学变化与脑梗死的相关性研究[J].中国实用神经疾病杂志, 2015, 11(7):86-88.GAO Y J, QU Y C, XUE Y D. Correlation between carotid atherosclerosis and hemodynamic changes and cerebral infarction[J].Chinese Journal of Practical Nervous Diseases, 2015, 11(7):86-88.
[8]杨克,张云山,刘秋颖,等.血液透析患者动脉粥样硬化的高频超声评价[J].海军医学杂志, 2013, 34(5):324-327.YANG K, ZHANG Y S, LIU Q Y, et al. High frequency ultrasound evaluation of atherosclerosis in hemodialysis patients[J]. Journal of Navy Medicine, 2013, 34(5):324-327.
[9]任永凤,王洲,李健,等.慢性肾病患者颈动脉多普勒超声应用及临床价值[J].蚌埠医学院学报, 2015, 40(4):513-516.REN Y F, WANG Z, LI J, et al. Application and clinical value of carotid Doppler ultrasound in patients with chronic kidney disease[J]. Journal of Bengbu Medical College, 2015, 40(4):513-516.
[10]SVENNINGSEN P, ANDERSEN H, NIELSEN L H, et al. Urinary serine proteases and activation of ENaC in kidney-implications for physiological renal salt handling and hypertensive disorders with albuminuria[J]. Pfluegers Arch, 2015, 467(3):531-542.
[11]段丽英,贾蓉.彩色多普勒超声在评估颈动脉粥样硬化斑块与脑梗死相关性中的应用价值研究[J].山西医药杂志, 2016, 45(15):1765-1767.DUAN L Y, JIA R. Application of color Doppler ultrasound in assessing the correlation between carotid atherosclerotic plaque and cerebral infarction[J]. Shanxi Medical Journal, 2016, 45(15):1765-1767.
[12]吴苑华,胡萍香,朱彤,等.超声弹性成像声触诊组织定量分析技术在慢性肾病中的应用价值[J].中国医学装备, 2016, 13(12):59-62.WU Y H, HU P X, ZHU T, et al. Application value of ultrasound elastography acoustic palpation tissue quantitative analysis technique in chronic kidney disease[J]. Chinese Medical Equipment, 2016, 13(12):59-62.
[13]SALK I, YILDIZ G, EGILMEZ H, et al. Carotid artery Doppler ultrasonography in patients with chronic kidney disease[J]. Med Sci Monit, 2014, 7(20):11-18.
[14]YU F P, ZHAO Y C, GU B, et al. Chronic kidney disease and carotid atherosclerosis in patients with acute stroke[J]. Neurologist, 2015, 20(2):23-29.
[15]HAKIMI S S, SABERI H, ROKNIYAZDI H, et al. Carotid artery stenosis in patients with chronic kidney disease undergoing dialysis:epidemiological aspects, main risk factors and appropriate diagnostic criteria[J]. Saudi J Kidney Dis Transpl, 2014, 25(1):58-65.
[16]AO D H, ZHAI F F, HAN F, et al. Large vessel disease modifies the relationship between kidney injury and cerebral small vessel disease[J]. Front Neurol, 2018, 26(9):498.
[17]赵蕊,吴玉林,安琳,等.超声诊断在老年慢性肾病中的应用价值研究[J].中国全科医学, 2012, 15(19):2181-2183.ZHAO R, WU Y L, AN L, et al. Application value of ultrasound diagnosis in elderly patients with chronic kidney disease[J]. Chinese Journal of General Practice, 2012, 15(19):2181-2183.