终末期肾功能衰竭患者动脉粥样硬化调查及危险因素分析

目的 调查终末期肾功能衰竭（ESRD）患者动脉粥样硬化（AS）的发生率并分析其危险因素。方法 颈动脉超声检查观测患者AS情况，同时测定血流动力学参数。包括收缩期峰值流速（SPV），舒张期峰值流速（DV）及阻力指数（RI）。收集患者临床情况。对血浆白蛋白，血脂成分，纤维蛋白原进行检测。结果 AS发生率为31%，非透析，血液透析与连续性非卧床腹膜透析（CAPD）患者间其发生率差异无显著性意义。逐步线性回归分析显示影响颈动脉内壁（IMT）增厚的因素。与颈动脉最大IMT相关的因素有缺血性心脑血管疾病史（R^2=0.3054,P=0.0001)，纤维蛋白原（R^2=0.3750,P=0.0037),RI(R^2=0.4062,P=0.0270)；与颈动脉平均IMT相关的因素有缺血性心脑血管疾病史（R^2=0.2606,P=0.0001)，DV（R^2=0.4375,P=0.0177)，年龄（R^2=0.3657,P=0.0001)，吸烟（R^2=0.4030,P=0.0161)。由Logestic回归分析确定的AS的3个危险因素分别是缺血性心脑血管疾病史，RI，吸烟，结论 颈AS总发生率为31%，确定了5个ESRD患者颈AS的危险因素，分别为年龄、吸烟，高血压，高纤维蛋白原和高RI，缺血性心脑血管病史对颈AS有很高的提示价值。ESRD本身可能就是AS源性因素，透析1-5年内未发现有加重AS的表现。颈动脉B超作为一种非创伤性检查手段对检测ESRD患者AS情况及随访都很有帮助。并可同时观测血流动力学状况。

Investigation of the prevalence of atherosclerosis and analysis of its risk factors in patients with end stage renal disease

Objective To investigate the prevalence of atherosclerosis and analyze the risk factors in patients with end stage renal disease(ESRD) Methods 100 ESRD patients were divided into three groups as non-dialysis ( n = 28), hemodialysis ( n = 31) and continuous ambulatory peritoneal dialysis (CAPD) ( n=41). Duration of dialysis ranged from 1 to 5 years. Their carotid atherosclerosis was evaluated and hemodynamic parameters, including velocity (systolic and diastolic) and resistance index ( RI) of common carotid artery were measured by B-ultrasound. Simultaneously their medical history and biochemical parameters were collected. Results 31 % of all patients presented carotid atherosclerosis, and no difference of the incidence among these three groups was found. Stepwise regression analysis showed that history of ischemic cerebrocardiovascular accidence( R~2=0. 3054, P=0. 0001), fibrinogen( R~2=0. 3750. P = 0. 0037) and RI( R~2=0. 4062, P= 0. 0270) were associated with the maximum IMT, and history of ischemic cerebrocardiovascular accidence( R~2 = 0. 2606, P = 0. 0001) , DV( R~2 = 0.4375, P = 0. 0177) ,age (R~2 = 0. 3657, P=0. 0001), cigarette smoking( R~2 = 0. 4030, P=0. 0161) were associated with the mean IMT. Logistic regression analysis identified three independent risk factors, namely history of ischemic cerebrocardiovascular accidence. cigarette smoking and RI. Gender, albumin, cholesterol, triglyceride. HDL, LDL, apoA/apoB100 and duration of dialysis were not significantly associated with carotid atherosclerosis. Conclusions The prevalence of carotid atherosclerosis is high, reaching 31% in ESRD patients. Risk factors correlated with carotid atherosclerosis in ESRD patients are age, smoking, hypertension. hyperfibrinogen, high resistance index (RI) . And history of ischemic cerebrocardiovasculer disease can indicate potential atherosclerosis. ESRD per se may be atherosclerogenesis and dialysis is not found to aggravate atherosclerosis in 1 to 5 years. Furthermore B-ultrasound of carotid artery as a non-invasion method is helpful for the identification of cardiovascular atherosclerosis and its follow-up in ESRD patients, meanwhile it can be used to measure hemodynamic parameters.