2018 年第 11 期 第 13 卷

维持性血液透析患者颈动脉钙化情况和血流参数的变化

Carotid calcification and ultrasonic blood flow characteristics in patients with maintenance hemodialysis

作者：胡文莉孙岩郭辉薛红荆忱范晓燕金玲张翠翠

英文作者：

单位：100089北京，空军航空医学研究所附属医院特诊科（胡文莉、郭辉、范晓燕、张翠翠），内二科（孙岩、荆忱），门诊部（薛红），体检中心（金玲）

英文单位：

关键词：血液透析；血管钙化；多普勒超声；颈动脉

英文关键词：

• 摘要：

• 【摘要】目的    探讨维持性血液透析患者颈动脉钙化情况和血流参数的变化。方法    选取2018年1—5月在空军航空医学研究所附属医院行维持性血液透析的慢性肾脏病患者30例（观察组），选择同期在我院体检健康者20名作为对照组，2组研究对象均接受颈动脉彩色多普勒超声检查。二维超声观察双侧颈总动脉及其分叉处、颈内动脉近段血管壁的3层结构，根据颈动脉钙化程度计算钙化积分。应用彩色多普勒显像观察血流充盈状况，脉冲多普勒采集血流频谱，测量收缩期峰值流速（PSV）、舒张末期流速（EDV）、搏动指数和阻力指数。比较观察组和对照组以及不同颈动脉钙化程度患者双侧颈总动脉和颈内动脉血流参数的差异。结果    观察组颈动脉中层钙化27例(90.0%),对照组2例（10.0%）；观察组颈动脉钙化积分为1~18分，中位数9.5分，对照组为0.5、1分。观察组左侧、右侧颈总动脉及颈内动脉EDV均低于对照组，搏动指数和阻力指数均高于对照组，左侧、右侧颈总动脉PSV均低于对照组，差异均有统计学意义（均P＜0.05）。维持性血液透析患者重度钙化组12例，轻度钙化组15例，重度钙化组左侧、右侧颈总动脉EDV均低于轻度钙化组［(4.9±2.3)cm/s比（7.4±2.1）cm/s，(6.0±2.5)cm/s比（7.2±2.7）cm/s］，左侧、右侧颈总动脉和颈内动脉阻力指数均高于轻度钙化组，差异均有统计学意义（均P＜0.05）。结论    颈动脉彩色多普勒超声检查可评价维持性血液透析患者血管钙化程度，判断血管弹性，可作为筛查透析患者风险分层的依据。

• 【Abstract】Objective    To observe carotid calcification and the changes of ultrasonic blood flow parameters in patients with maintenance hemodialysis. Methods    From January to May 2018, 30 patients with chronic renal failure undergoing maintenance hemodialysis in Hospital Attached to Aeromedicine Institute of the Chinese People′s Liberation Army were enrolled as observation group; 20 healthy people were enrolled as control group. All subjects had carotid color Doppler ultrasound examination. Structures of common and internal carotid arteries were observed by two-dimensional ultrasound. Carotid calcification score was calculated. Blood flow filling was observed by color Doppler. Blood flow spectrum was obtained by pulse Doppler. Peak systolic velocity（PSV）, end-diastolic velocity(EDV), pulse index and resistance index were measured. Results    There were 27 cases(90.0%) of carotid intima-media calcification in the observation group and 2 cases（10.0%） in the control group. The median calcification score in the observation group was 9.5（1-18）. Calcification scores of the 2 cases in the control group were 0.5 and 1. In the observation group, EDV of left and right common and internal carotid arteries were lower than those in the control group; pulse index and resistance index were higher than those in the control group; PSV of left and right common carotid arteries were lower than those in the control group（all P＜0.05）. Patients with carotid calcification were divided into severe group（n＝12） and mild group（n＝5）； EDV of left and right common carotid arteries in the severe group were lower than those in the mild group［(4.9±2.3)cm/s vs （7.4±2.1）cm/s， (6.0±2.5)cm/s vs （7.2±2.7）cm/s］; pulse index and resistance index of left and right common and internal carotid arteries in the severe group were higher than those in the mild group（all P＜0.05）. Conclusion    Color Doppler ultrasonography can evaluate the severity of carotid calcification and provide evidence for risk stratification in hemodialysis patients.