高频超声评价2型糖尿病肾病患者肾小球滤过率对颈动脉粥样硬化及血管重构的影响

目的探讨应用高频超声评价肾小球滤过率（GFR）对2型糖尿病肾病患者颈动脉内-中膜厚度（IMT）及颈动脉粥样硬化血管重构的影响。方法将2型糖尿病肾病患者按照GFR分为3组：GFR≥90ml/（min.1.73m2）为A组（34例）,60ml/（min.1.73m2）≤GFR〈90ml/（min.1.73m2）为B组（39例）,GFR〈60ml/（min.1.73m2）为C组（25例）。D组为正常人（50名）。应用高频超声测量颈动脉IMT、斑块部位的血管总面积（TVA）及管腔面积（LA）,计算重构指数（RI）。结果颈总动脉干、颈总动脉分叉处、颈内动脉、颈动脉平均IMT和血管重构率均为A组、B组和C组均高于D组（P均〈0.01）,B组和C组均高于A组（P均〈0.05）,C组高于B组（P均〈0.05）。颈动脉平均IMT与GFR呈负相关（r=-0.33,P〈0.05）。血管重构类型比较：仅C、D组间负性重构差异有统计学意义（P〈0.05）。D组中血管重构类型以无重构为主,其余各组中血管重构类型均以正性重构为主,且各组中正性重构发生率均高于负性重构发生率。结论糖尿病肾病患者随着GFR减低,颈动脉IMT逐渐增厚,GFR可影响颈动脉血管重构。高频超声可准确、快捷地监测糖尿病肾病患者GFR对颈动脉IMT及血管重构的影响。

High-frequency ultrasound in evaluation on the impact of glomerular filtration rate to carotid intima-media thickness and remodeling of carotid atherosclerosis for type 2 diabetes nephropathy patients

Objective To observe the impact of glomerular filtration rate(GFR) on intima-media thickness(IMT) of carotid and remodeling of carotid atherosclerosis in type 2 diabetes nephropathy patients with high-frequency ultrasound.Methods Patients with type 2 diabetes nephropathy were divided into 3 groups according to the level of GFR: 34 cases with GFR≥90 ml/(min·1.73 m2) in group A,39 with 60 ml/(min·1.73 m2)≤GFR<90 ml/(min·1.73 m2) in group B and the other 25 with GFR<60 ml/(min·1.73 m2) in group C.Meanwhile,50 healthy subjects were enrolled in group D as normal control.All subjects were examined with high-frequency ultrasound.IMT of carotid,total vessel area(TVA) and lumen area(LA) of the vessels with atherosclerotic plaque were measured,while the remodeling index(RI) and GFR were calculated.Results IMT of the trunk,bifurcation site of common carotid artery,the internal carotid artery,average IMT and remodeling rate of carotid atherosclerosis in group A,B and C were higher than those in group D(all P<0.01),those in group B and C were higher than those in group A(all P<0.05),those in group C were higher than those in group B(all P<0.05).Negative correlation was observed between GFR and average IMT(r=-0.33,P<0.05).There was a ascending trend of negative remodeling rate as GFR decreased,but significant difference was found only between group C and D(P<0.05).Vessels without remodeling was the main type in group D,but positive remodeling was the main type in group A,B and C,while the positive remodeling rates was higher than negative remodeling rates in all the groups.Conclusion In diabetic nephropathy patients,GFR is closely correlated with carotid IMT,indicating that the vessel remodeling is influenced by GFR.High-frequency ultrasound is a convenient and precise method in assessing the impact of GFR on IMT of carotid and remodeling of carotid atherosclerosis in diabetic nephropathy patients.