速度向量成像技术评价维持性血液透析患者颈动脉弹性的应用价值

张振; 夏纪筑; 彭雪莲; 邓家琦; 冯健

doi:10.3969/j.issn.2095-5227.2021.02.008

速度向量成像技术评价维持性血液透析患者颈动脉弹性的应用价值

Velocity vector imaging in evaluating carotid arterial elasticity in maintenance hemodialysis patients

摘要

摘要:
背景维持性血液透析(maintenance hemodialysis，MHD)是终末期肾衰竭(end stage renal disease，ESRD)患者最主要的治疗方式。而心血管疾病是维持性血液透析患者的主要死亡原因，与动脉粥样硬化关系密切。早期发现和防治动脉粥样硬化具有重要的临床意义。
目的探讨速度向量成像技术(velocity vector imaging，VVI)评价维持性血液透析患者颈动脉弹性的临床价值。
方法选择2019年5 - 12月于西南医科大学附属医院血液透析中心的MHD患者，根据颈动脉超声结果分为斑块组和无斑块组。另选颈动脉超声检查阴性的正常体检者为对照组。所有受试者均测量颈动脉内-中膜厚度(intima-media thickness，IMT)，VVI技术获取颈总动脉收缩期峰值圆周应变(circumferential strain，CS)、圆周应变率(circumferential strain rate，CSR)及血管面积改变率(ΔS)，并用脉压(pulse pressure，PP)校正CS，即CS/PP。比较各组相关参数并评价其诊断颈动脉粥样硬化斑块的能力。
结果共纳入MHD患者 86例，根据颈动脉超声结果分为斑块组30例、无斑块组56例；正常对照组30例。3组受试者年龄、性别、体质量指数、低密度脂蛋白胆固醇差异无统计学意义(P＞0.05)。斑块组ΔS、CS、CSR、CS/PP显著低于无斑块组和对照组(P均＜0.01)；而无斑块组上述指标低于对照组(P均＜0.05)；ΔS、CS、CSR、CS/PP与IMT呈负相关(r分别为-0.395、-0.321、-0.341、-0.461，P均＜0.001)，但相关度不高。ROC曲线显示ΔS、CS、CSR、CS/PP诊断颈动脉粥样硬化斑块的曲线下面积分别0.704、0.669、0.682、0.757(P均＜0.05)，CS/PP的预测能力最高。
结论 VVI技术能够有效评价维持性血液透析患者颈动脉弹性改变，可早期发现维持性血液透析患者颈动脉粥样硬化病变。

Abstract:
Background Maintenance hemodialysis (MHD) is the most important treatment for end stage renal disease (ESRD) patients. And cardiovascular disease is the main cause of death in maintenance hemodialysis patients, which is closely related to atherosclerosis. It has important clinical significance for detecting and preventing atherosclerosis early.
Objective To explore the clinical value of velocity vector imaging (VVI) in evaluating carotid artery elasticity in maintenance hemodialysis patients.
Methods Patients with maintenance hemodialysis (MHD) treated in the blood purification center of the Affiliated Hospital of Southwest Medical University from May to December in 2019 were enrolled. The patients were divided into CAP group and non-CAP group according to carotid artery plaque. And another 30 subjects without carotid artery plaque were severed as controls. Intima-media thickness (IMT) of carotid artery in each group was measured by conventional ultrasound. The systolic peak circumferential strain (CS), circumferential strain rate (CSR) and vascular area change rate (ΔS) of common carotid artery were obtained by VVI technique. CS was adjusted for pulse pressure (CS/PP). Statistical analysis was performed on each parameter.
Results There were 86 cases in the MHD group and 30 cases in the control group, and the MHD group was divided into the CAP group (n=30) and the non-CAP group (n=56). No significant difference was found in gender, age, BMI, and LDL-C between the three groups (P＞0.05). CS, CSR, ΔS and CS/PP of the CAP group were significantly lower than those of the non-CAP group and the control group (P＜0.01), and they were lower in the non-CAP group than in the control group (P＜0.05). IMT was negatively correlated with ΔS, CS, CSR, CS/PP (r=-0.395, -0.321, -0.341 and -0.461, respectively, P＜0.001). By the receiver operating characteristic curve (ROC) analysis, the area under the curve were 0.704, 0.669, 0.682 and 0.757 for ΔS, CS, CSR and CS/PP to predict the formation of carotid atherosclerotic plaque (all P＜0.05), and CS/PP had relatively high diagnostic value.
Conclusion VVI can evaluate the carotid elasticity changes of maintenance hemodialysis patients effectively, which suggests that it can find carotid atherosclerosis in maintenance hemodialysis patients in early stage.

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