血流剪切率对血液透析患者动脉硬化的评估

目的 应用超声多普勒技术探讨血流剪切率对血液透析患者动脉硬化的评估。方法 选择首都医科大学附属复兴医院血液透析患者，研究组为68例血液透析患者，对照组为48例健康体健者，按颈动脉是否存在硬化斑块将研究组及对照组再分为斑块阳性组和斑块阴性组。多普勒超声测定颈动脉内径、内中膜厚度（IMT），血流动力学参数并计算最大剪切率（SR），同时测定肱动脉血管内皮功能，并记录HD患者临床及生化指标。结果 研究组颈动脉SR、血管内皮功能明显低于对照组，研究组斑块阳性组低于阴性组（P〈0．05），研究组斑块阴性组低于对照组斑块阳性组，（P〈0．05），血液透析患者阳性组及阴性组比较，阳性组年龄、C-反应蛋白高于阴性组。结论 SR减低是血液透析患者血流动力学的变化特点，是观察血液透析患者动脉硬化发生和进展的特征之一。

Determination of shear rate in carotid artery for the evaluation of atherosclerosis in hemodialysis patients

Objective The usefulness of shear rate (SR) in carotid artery obtained by Doppler ultra- sonography for the evaluation of atherosclerosis in maintenance hemodialysis patients. Methods Sixty-eight pa- tients on hemodialysis and forty-eight normal individuals as the controls were included in this study. Atherosclerosis plaques in carotid artery were examined by Doppler ultrasonography. Diameter, intimal and medial thickness as well as hemodynamic parameters of the arteries were obtained, and the SR was calculated. Patients and normal controls were then subdivided into plaque positive groups and plaque negative groups. Flow mediated dilation in brachial artery was measured at the same time by ultrasonography. Results The SR in carotid arteries and flow mediated dilation in brachial arteries were significantly lower in patients than those in normal controls. The incidence rate of atherosclerosis plaque in carotid artery was higher in patients than that in normal controls (P < 0.05). In patients on hemodialysis, higher age and increased C- reactive protein were frequently seen in the plaque positive group. Conclusion Decreased SR is one of the hemodynamic features in maintenance hemodialysis patients. SR may be valuable for the detection of atherosclerosis and its progression in these patients.