剪切波弹性成像评估血液灌流对尿毒症血液透析患者颈动脉弹性的影响

Shear wave elastography to evaluate the effect of hemoperfusion on carotid artery elasticity in uremic patients undergoing hemodialysis

摘要:

目的]应用剪切波弹性成像(SWE)评估血液灌流对尿毒症血液透析患者颈动脉弹性的影响。 [方法]依据透析方案将78例尿毒症患者分为单纯血液透析组和血液透析联合血液灌流组,另纳入40名健康体检者为健康对照组。收集受检者基本信息、临床生物化学指标；应用常规超声测量颈动脉内膜中膜厚度(IMT)、收缩期末内径(Ds)、舒张期末内径(Dd)、收缩期血流峰值速度(PSV),计算获得管壁运动度(ΔD)和僵硬度系数(β)；应用SWE获取颈动脉前壁内中膜弹性模量最大值(ME_max)、弹性模量平均值(ME_mean)、弹性模量最小值(ME_min)。 [结果]三组间Ds、Dd、ΔD及PSV比较差异无统计学意义(均P＞0.05)。与健康对照组相比,血液透析联合血液灌流组和单纯血液透析组IMT、β和SWE参数明显升高(均P＜0.05)。与单纯血液透析组相比,血液透析联合血液灌流组SWE参数降低(P＜0.05),而IMT、β差异无统计学意义(均P＞0.05)。在三组中,SWE参数与IMT、β、低密度脂蛋白胆固醇呈正相关(r＞0.37,均P＜0.01),与高密度脂蛋白胆固醇呈负相关(|r|＞0.24,均P＜0.05)。SWE参数的ROC曲线下面积均高于常规超声参数(均P＜0.05)。 [结论]SWE能有效评估血液灌流对尿毒症血液透析患者颈动脉弹性的影响。

Abstract:

Aim To evaluate the effect of hemoperfusion on carotid artery elasticity in patients undergoing hemodialysis using shear wave elastography (SWE). Methods Seventy-eight patients with uremia were included, and divided into two groups based on dialysis regimen:hemodialysis alone group and hemodialysis combined with hemoperfusion group, while 40 healthy subjects were selected as control group. Then general information, clinical data and biochemical indices were collected. The carotid intima-media thickness (IMT), carotid artery inner diameter at the end of systole (Ds), the carotid artery inner diameter at the end of diastole (Dd) and the peak systolic flow velocity (PSV) were measured by conventional ultrasound. The degree of arterial wall motion (△D) and arterial stiffness coefficient (β) were calculated. Elasticity of intima-medial layer in the anterior carotid artery was measured by SWE, including the maximum modulus of elasticity (ME_max), mean modulus of elasticity (ME_mean), minimum modulus of elasticity (ME_min). Results There were no statistically significant differences in Ds, Dd, ΔD and PSV among the three groups (all P＞0.05). Compared with control group, the IMT, β, SWE parameters were significantly increased in the hemodialysis combined with hemoperfusion group and the hemodialysis alone group. Compared with hemodialysis alone group, the SWE parameters were significantly decreased in the hemodialysis combined with hemoperfusion group (P＜0.05), while there were no statistically significant differences in IMT and β (both P＞0.05). In the three groups, SWE parameters were positively correlated with IMT, β and LDLC (r＞0.37, all P＜0.01) and negatively correlated with HDLC (|r|>0.24, all P＜0.05). The areas under the ROC curves of the SWE parameters were all higher than those of the conventional ultrasound parameters (all P＜0.05). Conclusion SWE can effectively assess the effect of hemoperfusion on the elasticity of carotid arteries in uremic patients undergoing hemodialysis.