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目的应用彩色多普勒超声及血管回声跟踪(ET)技术探讨各期慢性肾脏病(CKD)患者颈动脉血流动力学及弹性的变化。方法慢性肾脏病患者100例,按病情分期分为CKD1~5期组,另选同期健康体检者30例为对照组,观测各组颈动脉血流动力学参数:阻力指数(RI)和搏动指数(PI),弹性参数:僵硬度指数(β)、血管压力-应变弹性系数(Ep)、点脉搏波传导速度(PWVβ)、顺应性(AC)及反射波增压指数(AI),分析CKD患者动脉血流动力学及弹性变化规律。结果与对照组、CKD1期组及CKD2期组比较,CKD4期组、CKD5期组的β、Ep、PWVβ均增大,AC减小;与对照组比较,CKD3期组β、Ep、PWVβ均增大,AC减小;CKD5期组AI较对照组和CKD1~3期组增大,差异均有统计学意义(P<0.05)。结论超声能够检测早期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。血流动力学参数出现显著性变化早于弹性参数的变化,能更早反映弹性大动脉硬化的改变。
Objective To investigate the changes of hemodynamics and elasticity of carotid arteries in patients with chronic kidney disease (CKD) by color Doppler ultrasonography and vascular echo tracing (ET). Methods One hundred patients with chronic kidney disease were divided into CKD group 1 to 5 according to the disease stage. Thirty healthy subjects were selected as the control group. The carotid hemodynamic parameters including resistance index (RI) and pulsatility index (PI), stiffness parameters (β), vascular pressure-strain elastic coefficient (Ep), PWVβ, compliance and reflex index (AI) Arterial hemodynamics and elasticity changes in patients. Results Compared with control group, CKD1 group and CKD2 group, β, Ep and PWVβ of CKD4 group and CKD5 group increased and AC decreased. Compared with control group, β, Ep and PWVβ in CKD3 group increased (P <0.05). The AI in CKD5 group was significantly higher than that in control group and CKD1 ~ 3 group (P <0.05). Conclusion Ultrasound can detect changes of arterial elasticity in patients with early CKD and is a simple and practical method to evaluate early atherosclerosis. Significant changes in hemodynamic parameters occurred earlier than the change of elastic parameters, which could reflect the change of elastic arteriosclerosis earlier.