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目的采用血管硬度检测技术(QAS)及应变与应变率成像技术(X-strain)评价进行不同钙浓度维持性血液透析患者颈动脉的弹性和形变能力的早期改变。方法随机选择60例标准钙透析患者,根据即将使用透析液浓度的不同分为:低钙组(使用低钙透析液,钙1.25 mmol/L)、标准钙组(使用标准透析液,钙1.50 mmol/L),每组30例。检测患者生化指标:包括血钙、血磷、甲状旁腺素(PTH)水平等,行颈动脉常规超声测得内中膜厚度(IMT)、阻力指数(RI)等相关参数,应用QAS技术和X-strain技术检测两组患者双侧颈动脉,分别得出两组数据顺应性系数CC、膨胀系数DC、弹性系数(α)、弹性系数(β)、脉搏波传导速度(PWV)、反射波增强指数(Alx)和最大圆周应变(Cs)、最大圆周应变率(Csr)等参数,进行统计学分析,比较其差异并进行相关性分析。结果 1血液透析6个月后低钙组的血钙、血磷、钙磷乘积较标准钙组显著降低(P<0.05),而PTH水平显著升高(P<0.05)。2血液透析6个月后低钙组IMT、RI、α、β、PWV、Alx数值较标准钙组显著降低(P<0.05),而Cs、Csr数值显著升高(P<0.05)。3IMT、α、β、PWV、Cs、Csr之间有相关性。4血钙对颈动脉弹性功能的影响显著。结论 QAS技术及X-strain技术可以较早评价不同钙浓度维持性血液透析患者颈动脉弹性及形变能力,了解心血管疾病的发展情况,及早调整方案,有益于临床诊疗。
Objective To evaluate the early changes of carotid artery elasticity and deformability in patients with different calcium concentration maintenance hemodialysis by using vascular stiffness test (QAS) and strain and strain rate imaging (X-strain). Methods Sixty patients with standard dialysis were randomly assigned to receive calcium dialysate (1.25 mmol / L, low calcium) and standard calcium (1.50 mmol / L), 30 cases in each group. The biochemical parameters of the patients were measured, including the levels of serum calcium, phosphorus and parathyroid hormone (PTH), IMT and RI, and the related parameters such as resistance index (RI) X-strain technique was used to detect the bilateral carotid arteries in both groups, and the data of compliance coefficient CC, coefficient of expansion DC, coefficient of elasticity (α), coefficient of elasticity (β), pulse wave velocity (PWV) (Alx), maximum circumferential strain (Cs) and maximum circumferential strain rate (Csr) were calculated and compared. The differences were compared and the correlation was analyzed. Results After 6 months of hemodialysis, the calcium, phosphorus, calcium and phosphorus products of hypocalcemia group decreased significantly (P <0.05) and PTH level increased significantly (P <0.05). The levels of IMT, RI, α, β, PWV and Alx in hypocalcemia group were significantly lower than those in the standard calcium group (P <0.05), while the values of Cs and Csr in hypocalcemia group were significantly increased 6 months after hemodialysis (P <0.05). 3IMT, α, β, PWV, Cs, Csr correlation between. 4 calcium on the carotid artery elastic function significantly. Conclusion QAS and X-strain techniques can evaluate the carotid artery elasticity and deformability of patients with maintenance hemodialysis in different calcium concentrations earlier, understand the development of cardiovascular diseases, adjust the program as soon as possible, and be beneficial for clinical diagnosis and treatment.