血管回声跟踪技术对慢性肾脏病患者动脉弹性功能的检测
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摘要
目的:心血管合并症是慢性肾脏病(chronic kidney disease, CKD)病人最主要的死亡原因之一。临床已充分证实慢性肾脏病存在动脉的损伤,并且该损伤可发生在动脉形态学改变之前,传统的血管影像学检查方法多以形态学改变作为诊断依据,不能达到早期发现的目的。本文应用血管回声跟踪技术和二维以及多普勒超声检测CKD患者颈动脉及桡动脉动脉弹性和动脉形态、结构的改变,分析CKD患者动脉病变的早期变化规律。评估CKD病程不同阶段的动脉病变情况,推断其对心血管系统影响,提供预测指标,为临床早期诊治提供依据。
方法:
1选择2008年12月-2009年12月在河北医科大学附属第四医院确诊的CKD住院患者共100例,颈总动脉(common carotid artery, CCA)和桡动脉(radial artery, RA)各100条,按照国际肾脏病病人生存质量指导(K/DOQI)分期标准,将CKD患者分为5组,每组20例,以同期健康体检者30例(CCA和RA各30条)作为正常对照组。
2应用ALOKAα-10彩色多普勒超声诊断仪检查各组CKD患者CCA、RA,测定血管内径(Inner Diameter, D)、内膜中层厚度(Intima-media thickness, IMT)、收缩期血流峰值流速(Peak systolic blood flow velocity, PSV)、阻力指数(Blood resistent index, RI)、搏动指数(Blood pulsatility index, PI),观察CCA、RA的二维结构情况,了解有无内膜中层增厚、硬化斑块的发生及斑块数量,以及有无管腔狭窄及闭塞和血流频谱形态异常。
3比较不同期CKD患者的CCA及RA血管管腔的二维(D、IMT)及血流动力学(RI、PI)变化规律,并与对照组进行比较。
4对组间无统计学意义的CKD期进行合并,并重新分组,进行组间比较,分析CKD各期的D、IMT、RI、PI等变化规律。
5应用血管回声跟踪(echo-tracking,ET)技术检测CKD患者的CCA、RA的弹性参数:硬化参数(Stiffness parameter,β)、血管压力-应变弹性系数(pressure-strain elasticty modulus, Ep)、血管顺应性(arterial compliance, AC)、增大指数(augmentation velocity index, AI)、脉搏波传导速度(one-point pulse wave velocity, PWVβ)。
6比较不同期CKD患者的CCA及RA的β、Ep、AC、PWVβ等参数间比较的变化规律情况,并与对照组进行比较。
7将CKD患者组间无统计学意义的组合并后重新分组,进一步分析CKD患者的β、Ep、AC、PWVβ等变化规律情况。结果:
1 CKD组尤其是CKD3、4、5期患者较对照组CCA、RA的内膜中层明显不规则增厚,回声增强,不光滑,部分患者管腔内可见单发或多发、形态不一的斑块形成。
2 CKD患者CCA的管径较对照组增大,RA的管径较对照组减小,CCA、RA的IMT均较对照组增厚,血流RI、PI均较对照组增高,且以CKD3、4、5期变化较显著( P <0.05)。
3将CKD患者的参数变化无统计学意义的组合并,按轻(CKD1、2)、中(CKD3)、重度(CKD4、5)重新分组比较,可见无论是CCA还是RA ,IMT、PSV、RI、PI参数均随病情加重逐渐增大,中、重度与轻度比较差异有统计学意义(P<0.05);且参数的变化与CKD患者的病程相一致。
4 CKD患者随病情加重CCA、RA的动脉弹性指标β、Ep、PWVβ均逐渐增高,AC值逐渐降低,以CKD3、4、5期显著(P<0.05)。
5将CKD各组间无统计学意义的组合并,按轻度(CKD1、2)、中度(CKD3)、重度(CKD4、5)重新分组,进行组间两两比较,可见:RA的β、Ep、PWVβ、AC在中度组(CKD3期)即全部出现明显异常变化,与轻度组比较有统计学意义(P<0.05);CCA仅PWVβ在中度组出现异常变化,与轻度组比较有统计学意义(P<0.05),而β、Ep和AC到重度组才出现有统计学意义的变化(P<0.05)。
结论:
1采用超声检查,能同时发现CCA和RA形态、结构和血流动力学的改变,可发现动脉硬化早期病变,明显提高CKD患者血管病变的检出率,为临床早期发现血管病变并实施干预措施提供依据。
2 CKD 3、4、5期患者CCA和RA的IMT、RI、PI有明显改变,IMT随CKD病程发展而增厚,RI、PI随CKD病程发展而增大,对评估CKD患者的病程发展有很好的参考价值。
3 CKD患者在动脉壁发生形态学改变之前,已经发生动脉弹性的改变。血管回声跟踪技术能够很好的检测早期CKD患者动脉弹性的变化,是评价早期动脉硬化简便实用的方法。
4在弹性大动脉CCA和肌性动脉RA,CKD患者的动脉弹性均较正常人减低;RA弹性变化可为终末期CKD患者行内瘘成形术的评估提供参考。
5 ET技术检测早期CKD患者即有动脉硬化的发生,表现为动脉弹性的改变,即β、Ep、PWVβ值升高, AC减低。按照肾损伤的程度合并分组后,CKD患者的组间动脉弹性差异更加明显。ET技术不仅可准确反映早期动脉弹性改变,而且并可作为临床随访指标,为临床早期发现血管病变并实施干预措施提供依据。
6 RA在CKD3期(中度组)的β、Ep、PWVβ、AC即出现明显变化,早于CCA的变化,说明肌性外周动脉可能是反映早期动脉弹性改变的更为敏感指标。
Objective: Cardiovascular complication is one of the main causes of death of Chronic Kidney Disease(CKD) patients. It is fully confirmed that each clinical phase of kidney disease may damage the artery and the damage occurs before the artery morphological changes. The traditional vascular Imaging examination basing on morphological changes can not diagnose the disease in time. In this paper, the study analyses the laws of early artery pathological changes of CKD patients by detecting the change of elasticity, morphology and structure of carotid and radial artery with Vascular echo-tracking technology and two-dimensional or Doppler ultrasound. The study provides the predictor and the basis of early clinical diagnosis and therapy for CKD, through assessing the laws of artery pathological changes at different stages of CKD and inferring their effects on the cardiovascular system.
Methods:
1. Select 100 CKD hospitalized patients as cases that were diagnosed in Hebei Medical University from December, 2008 to December,2009,common carotid artery (CCA ) and radial artery (RA) each 100 article.The CKD patients are divided into 5 groups according to the international common clinical staging standards (K/DOQI) basing on the life quality of CKD patients, each of which includes 20 cases. The control group includes 30 healthy cases in the same period.
2. With ALOKAα-10 Color Doppler ultrasound, detect the CCA and RA of each group of CKD patients, measure the blood vessel Inner Diameter (D), Intima-media thickness(IMT), Peak systolic blood flow velocity(PSV), early diastolic reverse flow velocity(Vr), End Diastolie veloeiyt(EDV), Blood resistent index(RI), Blood pulsatility index(PI). Observe the two-dimensional structure of CAA and RA in order to see whether IMT gets thicker and whether there is plaque and the number of plaque, to find whether there is the stenosis and occlusion and abnormal blood flow waveforms.
3. Detect the changing laws of two-dimensional blood vessel lumen (D,IMT) and blood flow dynamics (RI, PI) of CCA and RA. Compare them between CKD groups with the control group.
4. Combine and regroup the CKD stage groups that have no significant difference in statistics, and then compare between the new groups. Analyse the D,IMT,RI,PI parameters change laws of new CKD groups.
5. With application of echo-tracking technology(ET), detect the elastic parameters of CCA and RA of CKD patients. The parameters include Stiffness parameter(β), pressure-strain elasticty modulus(Ep), arterial compliance (AC), augmentation velocity index(AI), one-point pulse wave velocity (PWVβ).
6. Compare theβ, Ep, AC, PWVβchange laws of the CCA and RA in different period of CKD patients. Compare CKD group with the control group. 7. Combine and regroup the CKD staging groups that has no significant difference in statistics. Further analyse theβ、Ep、AC、PWVβchange laws of different new groups.
Results:
1. The Intima-media thickness(IMT) is irregularly thickened, echo enhanced, not smooth for CKD group, especially for CKD3,4,5 stage group(moderate or severe renal impairment group), compared with the control group. Some CKD patients can be seen with a single or multiple, varying morphological plaque in the blood vessel lumen.
2. The diameter of CCA becomes longer, the diameter of RA becomes shorter, the IMT of CCA/RA increases, RI/PI of blood flow get higher for CKD patient groups, especially for CKD3, 4,5, ( P <0.05), compared with the control group.
3. Combine the CKD patients whose parameters showed no significant change in statistics, and regroup them according to mild renal injury group (CKD1, 2), moderate renal impairment group(CKD3), severe renal impairment group (CKD4, 5). Through pairwise comparison between new recombined groups, it can be observed that whether for the mild groups (CKD1, 2 group) or for the moderate or severe groups (CKD3, 4,5 group), the IMT, RI , PSV, PI of CCA and RA all increase and the difference is significant ( P <0.05). The changes of the parameter is consistent with CKD stages of disease course.
4. Artery elasticity indexβ, Ep, PWVβgradually increased, and AC value gradually lower in CKD group, especially in CKD3, 4,5 ( P <0.05).
5. Combine the CKD patients whose parameters showed no significant change in statistics, and regroup them according to mild renal injury group (CKD1, 2), moderate renal impairment group(CKD3), severe renal impairment group (CKD4, 5). Through pairwise comparison between new recombined groups, it can be observed that for moderate group(CKD3),β/Ep/PWVβ/AC of RA all have significant abnormal changes, which is more meaningful in statistics than the mild groups (P <0.05); Only PWVβof CCA has abnormal change for moderate group, which is of statistical significance compared with the wild groups ( P <0.05); and the changes ofβ, Ep, AC parameters is only meaningful statistically in severe renal injury group ( P <0.05).
Conclusion:
1. Through ultrasound examination, we can find the morphologic, structural and hemodynamic change of carotid artery and radial artery. Then we can find early pathological changes of arteriosclerosis. The detection rate of vascular disease improved significantly in CKD patients. They provide the basis for detecting and taking measures of vascular pathological changes in the early clinical stage.
2. IMT,RI,PI of artery of moderate or severe renal impairment patients(CKD3, 4,5 group) has significant change. IMT is getting thicker, RI and PI are getting bigger with the development of CKD course. It can be used for assessing the development of the courses of CKD.
3. The change of artery elasticity occurred before the change of arterial wall morphology for CKD patients. Vascular echo-tracking technology can be a good early detection of artery elasticity changes of chronic kidney disease (CKD) patients, which is simple and practical method to evaluate early atherosclerosis.
4. The CCA(as the elastic arteries), and RA(as the muscular arteries) of CKD patients, is lower than those of normal subjects. RA flexibility change can provide reference for the fistula plasty preoperative evaluation of end-stage CKD patients.
5. Atherosclerosis occurs in the early stage of CKD, that is manifested as the changes in arterial elasticity.β,Ep,PWVβvalue increase and AC value decrease according to ET detection result. Arterial elasticity differences is more significant between the two CKD patient groups which is regrouped in accordance with the extent of renal injury. ET technique not only can accurately reflect the changes of arterial elasticity, but also as a clinical follow-up indicators, providing the basis for detecting and taking measures of vascular pathological changes in the early clinical stage.
6. The parametersβ, of Ep, PWVβand AC of RA part has significant changes in the moderate stage of renal injury stage (CKD3 period), which is earlier than the parameter changes of CCA. So it is possible that muscular peripheral artery may be the more sensitive indicators reflecting the early changes in arterial elasticity.
方法:
1选择2008年12月-2009年12月在河北医科大学附属第四医院确诊的CKD住院患者共100例,颈总动脉(common carotid artery, CCA)和桡动脉(radial artery, RA)各100条,按照国际肾脏病病人生存质量指导(K/DOQI)分期标准,将CKD患者分为5组,每组20例,以同期健康体检者30例(CCA和RA各30条)作为正常对照组。
2应用ALOKAα-10彩色多普勒超声诊断仪检查各组CKD患者CCA、RA,测定血管内径(Inner Diameter, D)、内膜中层厚度(Intima-media thickness, IMT)、收缩期血流峰值流速(Peak systolic blood flow velocity, PSV)、阻力指数(Blood resistent index, RI)、搏动指数(Blood pulsatility index, PI),观察CCA、RA的二维结构情况,了解有无内膜中层增厚、硬化斑块的发生及斑块数量,以及有无管腔狭窄及闭塞和血流频谱形态异常。
3比较不同期CKD患者的CCA及RA血管管腔的二维(D、IMT)及血流动力学(RI、PI)变化规律,并与对照组进行比较。
4对组间无统计学意义的CKD期进行合并,并重新分组,进行组间比较,分析CKD各期的D、IMT、RI、PI等变化规律。
5应用血管回声跟踪(echo-tracking,ET)技术检测CKD患者的CCA、RA的弹性参数:硬化参数(Stiffness parameter,β)、血管压力-应变弹性系数(pressure-strain elasticty modulus, Ep)、血管顺应性(arterial compliance, AC)、增大指数(augmentation velocity index, AI)、脉搏波传导速度(one-point pulse wave velocity, PWVβ)。
6比较不同期CKD患者的CCA及RA的β、Ep、AC、PWVβ等参数间比较的变化规律情况,并与对照组进行比较。
7将CKD患者组间无统计学意义的组合并后重新分组,进一步分析CKD患者的β、Ep、AC、PWVβ等变化规律情况。结果:
1 CKD组尤其是CKD3、4、5期患者较对照组CCA、RA的内膜中层明显不规则增厚,回声增强,不光滑,部分患者管腔内可见单发或多发、形态不一的斑块形成。
2 CKD患者CCA的管径较对照组增大,RA的管径较对照组减小,CCA、RA的IMT均较对照组增厚,血流RI、PI均较对照组增高,且以CKD3、4、5期变化较显著( P <0.05)。
3将CKD患者的参数变化无统计学意义的组合并,按轻(CKD1、2)、中(CKD3)、重度(CKD4、5)重新分组比较,可见无论是CCA还是RA ,IMT、PSV、RI、PI参数均随病情加重逐渐增大,中、重度与轻度比较差异有统计学意义(P<0.05);且参数的变化与CKD患者的病程相一致。
4 CKD患者随病情加重CCA、RA的动脉弹性指标β、Ep、PWVβ均逐渐增高,AC值逐渐降低,以CKD3、4、5期显著(P<0.05)。
5将CKD各组间无统计学意义的组合并,按轻度(CKD1、2)、中度(CKD3)、重度(CKD4、5)重新分组,进行组间两两比较,可见:RA的β、Ep、PWVβ、AC在中度组(CKD3期)即全部出现明显异常变化,与轻度组比较有统计学意义(P<0.05);CCA仅PWVβ在中度组出现异常变化,与轻度组比较有统计学意义(P<0.05),而β、Ep和AC到重度组才出现有统计学意义的变化(P<0.05)。
结论:
1采用超声检查,能同时发现CCA和RA形态、结构和血流动力学的改变,可发现动脉硬化早期病变,明显提高CKD患者血管病变的检出率,为临床早期发现血管病变并实施干预措施提供依据。
2 CKD 3、4、5期患者CCA和RA的IMT、RI、PI有明显改变,IMT随CKD病程发展而增厚,RI、PI随CKD病程发展而增大,对评估CKD患者的病程发展有很好的参考价值。
3 CKD患者在动脉壁发生形态学改变之前,已经发生动脉弹性的改变。血管回声跟踪技术能够很好的检测早期CKD患者动脉弹性的变化,是评价早期动脉硬化简便实用的方法。
4在弹性大动脉CCA和肌性动脉RA,CKD患者的动脉弹性均较正常人减低;RA弹性变化可为终末期CKD患者行内瘘成形术的评估提供参考。
5 ET技术检测早期CKD患者即有动脉硬化的发生,表现为动脉弹性的改变,即β、Ep、PWVβ值升高, AC减低。按照肾损伤的程度合并分组后,CKD患者的组间动脉弹性差异更加明显。ET技术不仅可准确反映早期动脉弹性改变,而且并可作为临床随访指标,为临床早期发现血管病变并实施干预措施提供依据。
6 RA在CKD3期(中度组)的β、Ep、PWVβ、AC即出现明显变化,早于CCA的变化,说明肌性外周动脉可能是反映早期动脉弹性改变的更为敏感指标。
Objective: Cardiovascular complication is one of the main causes of death of Chronic Kidney Disease(CKD) patients. It is fully confirmed that each clinical phase of kidney disease may damage the artery and the damage occurs before the artery morphological changes. The traditional vascular Imaging examination basing on morphological changes can not diagnose the disease in time. In this paper, the study analyses the laws of early artery pathological changes of CKD patients by detecting the change of elasticity, morphology and structure of carotid and radial artery with Vascular echo-tracking technology and two-dimensional or Doppler ultrasound. The study provides the predictor and the basis of early clinical diagnosis and therapy for CKD, through assessing the laws of artery pathological changes at different stages of CKD and inferring their effects on the cardiovascular system.
Methods:
1. Select 100 CKD hospitalized patients as cases that were diagnosed in Hebei Medical University from December, 2008 to December,2009,common carotid artery (CCA ) and radial artery (RA) each 100 article.The CKD patients are divided into 5 groups according to the international common clinical staging standards (K/DOQI) basing on the life quality of CKD patients, each of which includes 20 cases. The control group includes 30 healthy cases in the same period.
2. With ALOKAα-10 Color Doppler ultrasound, detect the CCA and RA of each group of CKD patients, measure the blood vessel Inner Diameter (D), Intima-media thickness(IMT), Peak systolic blood flow velocity(PSV), early diastolic reverse flow velocity(Vr), End Diastolie veloeiyt(EDV), Blood resistent index(RI), Blood pulsatility index(PI). Observe the two-dimensional structure of CAA and RA in order to see whether IMT gets thicker and whether there is plaque and the number of plaque, to find whether there is the stenosis and occlusion and abnormal blood flow waveforms.
3. Detect the changing laws of two-dimensional blood vessel lumen (D,IMT) and blood flow dynamics (RI, PI) of CCA and RA. Compare them between CKD groups with the control group.
4. Combine and regroup the CKD stage groups that have no significant difference in statistics, and then compare between the new groups. Analyse the D,IMT,RI,PI parameters change laws of new CKD groups.
5. With application of echo-tracking technology(ET), detect the elastic parameters of CCA and RA of CKD patients. The parameters include Stiffness parameter(β), pressure-strain elasticty modulus(Ep), arterial compliance (AC), augmentation velocity index(AI), one-point pulse wave velocity (PWVβ).
6. Compare theβ, Ep, AC, PWVβchange laws of the CCA and RA in different period of CKD patients. Compare CKD group with the control group. 7. Combine and regroup the CKD staging groups that has no significant difference in statistics. Further analyse theβ、Ep、AC、PWVβchange laws of different new groups.
Results:
1. The Intima-media thickness(IMT) is irregularly thickened, echo enhanced, not smooth for CKD group, especially for CKD3,4,5 stage group(moderate or severe renal impairment group), compared with the control group. Some CKD patients can be seen with a single or multiple, varying morphological plaque in the blood vessel lumen.
2. The diameter of CCA becomes longer, the diameter of RA becomes shorter, the IMT of CCA/RA increases, RI/PI of blood flow get higher for CKD patient groups, especially for CKD3, 4,5, ( P <0.05), compared with the control group.
3. Combine the CKD patients whose parameters showed no significant change in statistics, and regroup them according to mild renal injury group (CKD1, 2), moderate renal impairment group(CKD3), severe renal impairment group (CKD4, 5). Through pairwise comparison between new recombined groups, it can be observed that whether for the mild groups (CKD1, 2 group) or for the moderate or severe groups (CKD3, 4,5 group), the IMT, RI , PSV, PI of CCA and RA all increase and the difference is significant ( P <0.05). The changes of the parameter is consistent with CKD stages of disease course.
4. Artery elasticity indexβ, Ep, PWVβgradually increased, and AC value gradually lower in CKD group, especially in CKD3, 4,5 ( P <0.05).
5. Combine the CKD patients whose parameters showed no significant change in statistics, and regroup them according to mild renal injury group (CKD1, 2), moderate renal impairment group(CKD3), severe renal impairment group (CKD4, 5). Through pairwise comparison between new recombined groups, it can be observed that for moderate group(CKD3),β/Ep/PWVβ/AC of RA all have significant abnormal changes, which is more meaningful in statistics than the mild groups (P <0.05); Only PWVβof CCA has abnormal change for moderate group, which is of statistical significance compared with the wild groups ( P <0.05); and the changes ofβ, Ep, AC parameters is only meaningful statistically in severe renal injury group ( P <0.05).
Conclusion:
1. Through ultrasound examination, we can find the morphologic, structural and hemodynamic change of carotid artery and radial artery. Then we can find early pathological changes of arteriosclerosis. The detection rate of vascular disease improved significantly in CKD patients. They provide the basis for detecting and taking measures of vascular pathological changes in the early clinical stage.
2. IMT,RI,PI of artery of moderate or severe renal impairment patients(CKD3, 4,5 group) has significant change. IMT is getting thicker, RI and PI are getting bigger with the development of CKD course. It can be used for assessing the development of the courses of CKD.
3. The change of artery elasticity occurred before the change of arterial wall morphology for CKD patients. Vascular echo-tracking technology can be a good early detection of artery elasticity changes of chronic kidney disease (CKD) patients, which is simple and practical method to evaluate early atherosclerosis.
4. The CCA(as the elastic arteries), and RA(as the muscular arteries) of CKD patients, is lower than those of normal subjects. RA flexibility change can provide reference for the fistula plasty preoperative evaluation of end-stage CKD patients.
5. Atherosclerosis occurs in the early stage of CKD, that is manifested as the changes in arterial elasticity.β,Ep,PWVβvalue increase and AC value decrease according to ET detection result. Arterial elasticity differences is more significant between the two CKD patient groups which is regrouped in accordance with the extent of renal injury. ET technique not only can accurately reflect the changes of arterial elasticity, but also as a clinical follow-up indicators, providing the basis for detecting and taking measures of vascular pathological changes in the early clinical stage.
6. The parametersβ, of Ep, PWVβand AC of RA part has significant changes in the moderate stage of renal injury stage (CKD3 period), which is earlier than the parameter changes of CCA. So it is possible that muscular peripheral artery may be the more sensitive indicators reflecting the early changes in arterial elasticity.
引文
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6 JONO S, MCKEE M D, MURRY C E, et al Phosphate regulation of vascular smooth muscle cell calcification. Circ Res, 2000,87:10-17.
7 Moe SM, Duan D, Doehle BP, et al. Uremia induces the osteoblast differentiation factor Cbfa1 in humam blood vessels. Kidney Int,2003, 63(3):1003-1011
8 Jono S, Mckee MD, Murry CE, et al. Phosphate regulation of vascular smooth muscle cell calcification.Circ Res,2000,87(7):E10-E17
9徐也鲁.动脉粥样硬化一一种慢性炎症过程.中国动脉硬化杂志,2001,9:93-95
10 Wanner C, Metzger T. C-reactive protein a marker for all-cause and cardiovascular mortality in haemodialysis patients. Nephrol Dial Transplant,2002,17(8):29-32
11 Park CW, Shin YS, Kim CM, et al. Increased C-reactive protein following hemodialysis predicts cardiac hypertrophy in chronic hemodialysis patients.Am J Kidney Dis,2002,40(6):1230-1239
12 Peter A, Mccullough. Evaluation and treatment of coronary artery disease in patients with end-stage renal disease. Kidney Int,2005,67( 95):S51-S58
13 Georulkaos G,Ogorman DJ,Kalodiki E,et al. The intimal media thiekness as a markerof the Presence of sveere SymPtomatci Coronayr artery disease. Eur Heart J,1994,15:781-785.
14翟林,张丹,张缙熙.超声检测颈动脉对血透患者心血管病变的预测.中国超声诊断杂志,2003,4(11):825-827
15 Papagianni A, Dovas S, Bantis C, et a.l Carotid atherosclerosis and endothelial cell adhesion molecules as predictors of long-term outcome in chronic hemodialysis patients. Am JNephro,2008,28:265-274
16史均宝,史春迎,庄震.慢性肾脏病患者颈-股动脉脉搏波速度改变及其影响因素.中国组织工程研究与临床康复,2009,13(26):5108-5112
1 McCullough PA, Jurkovitz CT, Pergola PE, et al. Independent components of chronic kidney disease as a cardiovascular risk state: Resultfrom theKidney Early Evaluation Program(KEEP).Arch InternMed,2007,167: 1122-1129
2柴启亮,詹嘉,陈悦,等.E-Tracking技术评价颈动脉病变的临床应用.上海医学影像,2006,15(2):160-161
3刘伟,林汉生. SPSS在完全随机设计多个样本间多重比较Nemenyi秩和检验中的应用.中国卫生统计,2009,26(2):214-216
4 VanPopele NM, Grobbee DE, BotsML, et al.Association between arterial stiffness and atherosclerosis: the Rotter damstudy. Stroke,2001,32(2): 454-460
5张维忠.动脉弹性功能临床研究的现状和意义.中华心血管病杂志,2003,31(4):243-244
6 Wiinberg N. Measurement of arterial compliance in vivo. Stud Health Technol Inform,2000,71:99-108
7 Safer ME, Levy BI, Struijker-Boudier H. Current perspectives arterial stiffness and pressure in hypertension and cardiovascular disease.Circulation,2004,107(22):2864-2869
8卢漫,唐红,黄鹤.应用回声跟踪技术对围绝经期妇女早期动脉硬化的研究.中国超声医学杂志,2005,21(5):364-366
9关晓猛,杨晓英,徐卉,等.血管壁回声跟踪技术评价吸烟患者血管内皮功能.中国临床医学影像杂志,2006,17(5):269-271
10 Akimitsu Harada,Takashi okada,Kiyomi Niki,et al.New Methods of one-point measurement of pulse wave velocity. IEEE Ultrasonies Symposium,2002:1835-1838
11华琦,谭静,刘东霞,等.高血压患者颈股动脉及颈桡动脉脉搏波传导速度改变及其影响因素.中华心血管病杂志,2005,33(12):1088-1091
12罗燕,林玲,彭玉兰.血管回声跟踪技术对颈动脉单点脉搏波传导速度的检测及其意义.中国超声医学杂志,2007,23(3):206-208
13罗燕,邱逦,陈红艳,等.血管回声跟踪技术检测终末期肾病患者颈动脉弹性功能.中国超声医学杂志,2007,23(1):38-40
14李汇文.回声跟踪技术评价颈动脉弹性研究进展.内蒙古中医药,2008,8:69-71
15肖沪生,徐智章,张爱宏,等. e-TRACKING技术的原理及参数探讨.上海医学影像.2006,14(2):84-86
16 London GM, Marchais SJ, Guerin AP, et al. Arteriosclerosis,vascular calcifications and cardiovascular disease in uremia.Curr Opin Nephrol Hypertens,2005,14(6):525-531
17俞香宝,王宁宁,王笑云.尿毒症患者桡动脉钙化与动静脉内瘘术中血栓形成关系的研究.南京医科大学学报(自然科学版),2007,5:515-516
1王海燕.肾脏病学(第三版).人民卫生出版社,2008,9:1930
2严子君,张瑞岩,慢性肾脏病患者动脉僵硬度研究进展.临床内科杂志, 2008,25(7):443-445
3芦娜,王宏宇.血管病变检测方法概述.中国民康医学心脑血管专版,2005,17(2):106-111
4柳兆荣,李惜惜.血液动力学原理与方法.上海复旦大学出版社, 1997,12:168-196
5 Hansen TW, Jeppesen J, Rasmussen S, et al. Relation between insulin and aortic stiffness:a population2based study.J Hypertens,2004,18:127
6史均宝,史春迎,庄震,等.慢性肾脏病患者颈-股动脉脉搏波速度改变及其影响因素.中国组织工程研究与临床康复.2009,13(26):5108-5112
7 Blaeher J, Pannier B, Guerin AP, et al. Carotid arterial stiffness as apredietor of cardovascular and all-cause mortahty in end stage renal disease. Hypertension,l998,32(3):570-574
8 Liang YL, Teede H, Kotsopoulos D, et al. Noninvasive measurements of arterial structure and function:repeatability, interrelationships and trial sample size.Clin Sci, 1998,95:669-679
9郭志平,林金.动脉功能无创性检测的常用指标.中华高血压杂志,2009,17(6):569-573
10张维忠.降压治疗新视点:中心动脉压.中华心血管病杂志,2006,34(5): 471-473
11 Takenaka T, Mimura T, Kikuta T, et al. Time for reflection predicts the progression of renal dysfunction in patients with nondiabetic chronic kidney disease. Clin Exp Hypertens, 2009,31(3):220-30
12张瑜.对慢性肾脏病患者增强指数及颈动脉内中膜厚度的相关因素分析.北京:北京中医药大学,2009
13 Cohn JN. Arterialco mplianceto stratifyc ardiovas cularri sk:moerp recisionin therapeuticdecision making. A MJ H ypertens,2001,l4:258-256
14 Elizabeth G, Chris B, Stephe PG, et al. Reduced small artery but not large artery elasticity is an independent risk marker for cardio-vascular events. Hypertens,2003,16:265-269
15 Domanski M,Norman J,Wolz M,et al. Cardiovascular risk assessment using pulse pressure in the first national health and nut rition exami nation survey.Hypertension,2001,38(4):793-797
16 Franklin SS,Khan SA,Wong ND,et al. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham heart study. Circulation,1999,100(4):354-360
17 Safar ME, Blacher J, Pannier B, et al. Central pulse pressure and mortality in end-stage renal disease. Hypertension,2002,39:735
18许竹梅.超声检测动脉粥样硬化的进展:颈动脉内膜中层厚度的意义.心血管病学进展,1998,19(6):354-357
19 Pignoli P, Tremoli E, Poli A, et al. Intimal plus medial thickness of the arterial wall: A direct measurement with ultrasound imaging. Circulation, 1986,74(6):1399-1406
20伍建红,肖金海.高血压病患者颈动脉内膜-中层厚度与腹主动脉弹性的超声检测.中国超声诊断杂志,2004,5(4):243-245
21 savage T, clarke AL, giles M, et al.caleififed plaque is common in thecarotid and femoral arteries of dialysis patients without clinical vascular disease. Nephrol Dial Transplant,1998,13:2004-2012
22姚英,刘惠兰,王银娜,等.血液透析患者血磷与颈动脉内-中膜厚度的关系.中国血液化,2007,12:411-414
23 NiKi K, Sugawara M, Chang D, et al. A new noninvasive measurement system for wave intensity: evaluation of carotid arterial wave intensity reproducibility. Heart Vessels,2002,17:12-21
24肖沪生,徐智章,等. e-TRACKING技术的原理及参数探讨.上海医学像,2006,2:84-86
25肖沪生,银浩强,等. 274例e-TRACKING参数相关性分析及影响因素探讨.上海医学影像,2006,2:90-92
26 Hayashi K, Handa H, Nagasawa S,et al.Stiffness and elastic behavior of human intracranial and extracranial arteries. Biomech,1980,13:175-184
27 Masanori E, Kyoko I, Yoshiki N, et al.Stiffness indexesβof the common carotid and femoral arteries are associated with insulin resistance in NIDDM. Diabetes Care,1998,7(21):1178-1182
28 Kawasaki T, Sasayama S, Yagi S, et al. Noninvasive measurement of the age related changes in stiffness of major branches of the human arteries. Cardiovasc Res,1987,21:678-687
29 Kahiro A, masanori E, Megumi T, et al. Effect of adiponectin on carotid arterial stiffness in type 2 diabetic patients treated with pioglitazone and metfomin. Metabolism Clinical and Experimental,2006,55:996-1001
30罗燕,林玲,彭玉兰,等.血管回声跟踪技术对颈动脉单点脉搏波传导速度的检测及其意义.中国超声医学杂志,2007,23:206-208
31肖沪生,彭欣,银浩强,等. E-TRACKING管径增大指数的原理及影响因素探讨.上海医学影像,2007,16(1):8-10
32 Vvas M, Izzo JL Jr, Lacourciere Y, et al.Augmentation index and central aortic stiffness in middle-aged to elderly individuals. Am J Hypertens, 2007,20:642-647
33罗燕,邱逦,陈红艳,等.血管回声跟踪技术检测终末期肾病患者颈动脉弹性功能.中国超声医学杂志,2007,23(1):38-40
2许竹梅,赵小平,范平.超声测量颈动脉内膜中层厚度与颈动脉斑块的关系.中国动脉硬化杂志,2000,8(2):165-168
3张梅,张运,高月花,等.颈动脉及股动脉内膜-中膜层厚度正常值的对比研究.中国医学影像技术,2002,18(1):32-33
4刘伟,林汉生. SPSS在完全随机设计多个样本间多重比较Nemenyi秩和检验中的应用.中国卫生统计,2009,26(2):214-216
5杜国伟,鲍晓荣.早期慢性肾脏疾病与心血管疾病的关系.中国临床医学,2006,13(1):126-128
6 JONO S, MCKEE M D, MURRY C E, et al Phosphate regulation of vascular smooth muscle cell calcification. Circ Res, 2000,87:10-17.
7 Moe SM, Duan D, Doehle BP, et al. Uremia induces the osteoblast differentiation factor Cbfa1 in humam blood vessels. Kidney Int,2003, 63(3):1003-1011
8 Jono S, Mckee MD, Murry CE, et al. Phosphate regulation of vascular smooth muscle cell calcification.Circ Res,2000,87(7):E10-E17
9徐也鲁.动脉粥样硬化一一种慢性炎症过程.中国动脉硬化杂志,2001,9:93-95
10 Wanner C, Metzger T. C-reactive protein a marker for all-cause and cardiovascular mortality in haemodialysis patients. Nephrol Dial Transplant,2002,17(8):29-32
11 Park CW, Shin YS, Kim CM, et al. Increased C-reactive protein following hemodialysis predicts cardiac hypertrophy in chronic hemodialysis patients.Am J Kidney Dis,2002,40(6):1230-1239
12 Peter A, Mccullough. Evaluation and treatment of coronary artery disease in patients with end-stage renal disease. Kidney Int,2005,67( 95):S51-S58
13 Georulkaos G,Ogorman DJ,Kalodiki E,et al. The intimal media thiekness as a markerof the Presence of sveere SymPtomatci Coronayr artery disease. Eur Heart J,1994,15:781-785.
14翟林,张丹,张缙熙.超声检测颈动脉对血透患者心血管病变的预测.中国超声诊断杂志,2003,4(11):825-827
15 Papagianni A, Dovas S, Bantis C, et a.l Carotid atherosclerosis and endothelial cell adhesion molecules as predictors of long-term outcome in chronic hemodialysis patients. Am JNephro,2008,28:265-274
16史均宝,史春迎,庄震.慢性肾脏病患者颈-股动脉脉搏波速度改变及其影响因素.中国组织工程研究与临床康复,2009,13(26):5108-5112
1 McCullough PA, Jurkovitz CT, Pergola PE, et al. Independent components of chronic kidney disease as a cardiovascular risk state: Resultfrom theKidney Early Evaluation Program(KEEP).Arch InternMed,2007,167: 1122-1129
2柴启亮,詹嘉,陈悦,等.E-Tracking技术评价颈动脉病变的临床应用.上海医学影像,2006,15(2):160-161
3刘伟,林汉生. SPSS在完全随机设计多个样本间多重比较Nemenyi秩和检验中的应用.中国卫生统计,2009,26(2):214-216
4 VanPopele NM, Grobbee DE, BotsML, et al.Association between arterial stiffness and atherosclerosis: the Rotter damstudy. Stroke,2001,32(2): 454-460
5张维忠.动脉弹性功能临床研究的现状和意义.中华心血管病杂志,2003,31(4):243-244
6 Wiinberg N. Measurement of arterial compliance in vivo. Stud Health Technol Inform,2000,71:99-108
7 Safer ME, Levy BI, Struijker-Boudier H. Current perspectives arterial stiffness and pressure in hypertension and cardiovascular disease.Circulation,2004,107(22):2864-2869
8卢漫,唐红,黄鹤.应用回声跟踪技术对围绝经期妇女早期动脉硬化的研究.中国超声医学杂志,2005,21(5):364-366
9关晓猛,杨晓英,徐卉,等.血管壁回声跟踪技术评价吸烟患者血管内皮功能.中国临床医学影像杂志,2006,17(5):269-271
10 Akimitsu Harada,Takashi okada,Kiyomi Niki,et al.New Methods of one-point measurement of pulse wave velocity. IEEE Ultrasonies Symposium,2002:1835-1838
11华琦,谭静,刘东霞,等.高血压患者颈股动脉及颈桡动脉脉搏波传导速度改变及其影响因素.中华心血管病杂志,2005,33(12):1088-1091
12罗燕,林玲,彭玉兰.血管回声跟踪技术对颈动脉单点脉搏波传导速度的检测及其意义.中国超声医学杂志,2007,23(3):206-208
13罗燕,邱逦,陈红艳,等.血管回声跟踪技术检测终末期肾病患者颈动脉弹性功能.中国超声医学杂志,2007,23(1):38-40
14李汇文.回声跟踪技术评价颈动脉弹性研究进展.内蒙古中医药,2008,8:69-71
15肖沪生,徐智章,张爱宏,等. e-TRACKING技术的原理及参数探讨.上海医学影像.2006,14(2):84-86
16 London GM, Marchais SJ, Guerin AP, et al. Arteriosclerosis,vascular calcifications and cardiovascular disease in uremia.Curr Opin Nephrol Hypertens,2005,14(6):525-531
17俞香宝,王宁宁,王笑云.尿毒症患者桡动脉钙化与动静脉内瘘术中血栓形成关系的研究.南京医科大学学报(自然科学版),2007,5:515-516
1王海燕.肾脏病学(第三版).人民卫生出版社,2008,9:1930
2严子君,张瑞岩,慢性肾脏病患者动脉僵硬度研究进展.临床内科杂志, 2008,25(7):443-445
3芦娜,王宏宇.血管病变检测方法概述.中国民康医学心脑血管专版,2005,17(2):106-111
4柳兆荣,李惜惜.血液动力学原理与方法.上海复旦大学出版社, 1997,12:168-196
5 Hansen TW, Jeppesen J, Rasmussen S, et al. Relation between insulin and aortic stiffness:a population2based study.J Hypertens,2004,18:127
6史均宝,史春迎,庄震,等.慢性肾脏病患者颈-股动脉脉搏波速度改变及其影响因素.中国组织工程研究与临床康复.2009,13(26):5108-5112
7 Blaeher J, Pannier B, Guerin AP, et al. Carotid arterial stiffness as apredietor of cardovascular and all-cause mortahty in end stage renal disease. Hypertension,l998,32(3):570-574
8 Liang YL, Teede H, Kotsopoulos D, et al. Noninvasive measurements of arterial structure and function:repeatability, interrelationships and trial sample size.Clin Sci, 1998,95:669-679
9郭志平,林金.动脉功能无创性检测的常用指标.中华高血压杂志,2009,17(6):569-573
10张维忠.降压治疗新视点:中心动脉压.中华心血管病杂志,2006,34(5): 471-473
11 Takenaka T, Mimura T, Kikuta T, et al. Time for reflection predicts the progression of renal dysfunction in patients with nondiabetic chronic kidney disease. Clin Exp Hypertens, 2009,31(3):220-30
12张瑜.对慢性肾脏病患者增强指数及颈动脉内中膜厚度的相关因素分析.北京:北京中医药大学,2009
13 Cohn JN. Arterialco mplianceto stratifyc ardiovas cularri sk:moerp recisionin therapeuticdecision making. A MJ H ypertens,2001,l4:258-256
14 Elizabeth G, Chris B, Stephe PG, et al. Reduced small artery but not large artery elasticity is an independent risk marker for cardio-vascular events. Hypertens,2003,16:265-269
15 Domanski M,Norman J,Wolz M,et al. Cardiovascular risk assessment using pulse pressure in the first national health and nut rition exami nation survey.Hypertension,2001,38(4):793-797
16 Franklin SS,Khan SA,Wong ND,et al. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham heart study. Circulation,1999,100(4):354-360
17 Safar ME, Blacher J, Pannier B, et al. Central pulse pressure and mortality in end-stage renal disease. Hypertension,2002,39:735
18许竹梅.超声检测动脉粥样硬化的进展:颈动脉内膜中层厚度的意义.心血管病学进展,1998,19(6):354-357
19 Pignoli P, Tremoli E, Poli A, et al. Intimal plus medial thickness of the arterial wall: A direct measurement with ultrasound imaging. Circulation, 1986,74(6):1399-1406
20伍建红,肖金海.高血压病患者颈动脉内膜-中层厚度与腹主动脉弹性的超声检测.中国超声诊断杂志,2004,5(4):243-245
21 savage T, clarke AL, giles M, et al.caleififed plaque is common in thecarotid and femoral arteries of dialysis patients without clinical vascular disease. Nephrol Dial Transplant,1998,13:2004-2012
22姚英,刘惠兰,王银娜,等.血液透析患者血磷与颈动脉内-中膜厚度的关系.中国血液化,2007,12:411-414
23 NiKi K, Sugawara M, Chang D, et al. A new noninvasive measurement system for wave intensity: evaluation of carotid arterial wave intensity reproducibility. Heart Vessels,2002,17:12-21
24肖沪生,徐智章,等. e-TRACKING技术的原理及参数探讨.上海医学像,2006,2:84-86
25肖沪生,银浩强,等. 274例e-TRACKING参数相关性分析及影响因素探讨.上海医学影像,2006,2:90-92
26 Hayashi K, Handa H, Nagasawa S,et al.Stiffness and elastic behavior of human intracranial and extracranial arteries. Biomech,1980,13:175-184
27 Masanori E, Kyoko I, Yoshiki N, et al.Stiffness indexesβof the common carotid and femoral arteries are associated with insulin resistance in NIDDM. Diabetes Care,1998,7(21):1178-1182
28 Kawasaki T, Sasayama S, Yagi S, et al. Noninvasive measurement of the age related changes in stiffness of major branches of the human arteries. Cardiovasc Res,1987,21:678-687
29 Kahiro A, masanori E, Megumi T, et al. Effect of adiponectin on carotid arterial stiffness in type 2 diabetic patients treated with pioglitazone and metfomin. Metabolism Clinical and Experimental,2006,55:996-1001
30罗燕,林玲,彭玉兰,等.血管回声跟踪技术对颈动脉单点脉搏波传导速度的检测及其意义.中国超声医学杂志,2007,23:206-208
31肖沪生,彭欣,银浩强,等. E-TRACKING管径增大指数的原理及影响因素探讨.上海医学影像,2007,16(1):8-10
32 Vvas M, Izzo JL Jr, Lacourciere Y, et al.Augmentation index and central aortic stiffness in middle-aged to elderly individuals. Am J Hypertens, 2007,20:642-647
33罗燕,邱逦,陈红艳,等.血管回声跟踪技术检测终末期肾病患者颈动脉弹性功能.中国超声医学杂志,2007,23(1):38-40