使用超快超声成像技术量化慢性肾脏病患者的颈动脉僵硬度。

Quantifying carotid stiffness in chronic kidney disease using ultrafast ultrasound imaging.

作者信息

Huang Hui, Zhu Zhengqiu, Wang Han, Ma Xuehui, Liu Wenjun, Wu Yiyun, Zou Chong, Wang Yinping, Shen Bixiao, Ge Weiming, Gao Hui, Luan Yun, Jiang Xuezhong

机构信息

Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.

Department of Geriatric, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.

出版信息

Quant Imaging Med Surg. 2024 Jan 3;14(1):75-85. doi: 10.21037/qims-23-503. Epub 2023 Oct 13.

DOI:10.21037/qims-23-503

PMID:38223093

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10784014/

Abstract

BACKGROUND

The mortality and disability of chronic kidney disease (CKD) are highly linked to the incidence of atherosclerotic cardiovascular events. Numerous clinical biochemical indicators of renal function often only increase in advanced stages of CKD, driving an urgent need for reliable indicators of atherosclerosis in early CKD. Ultrafast pulse wave velocity (ufPWV) can evaluate the stiffness of the straight carotid and quantitatively reflect the degree of early atherosclerosis. However, the use of ufPWV in CKD has not yet been reported. In this study, we aimed to explore the association between carotid stiffness, quantified using ufPWV, and renal function in CKD patients.

METHODS

This cross-sectional study enrolled a total of 582 participants between March 2017 and May 2022 in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine. Among those, 205 individuals without a history of CKD and estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m were included as controls. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI) expert group of the American Kidney Foundation staging for CKD, 44 stages 1 and 2 CKD patients were included in the early CKD group, whereas 49 stages 3, 4, and 5 CKD patients were included in the advanced CKD group. Clinical and serum parameters, ultrasonic characteristics including carotid intima-media thickness (cIMT), and pulse wave velocity at the beginning of systole (PWV-BS) and pulse wave velocity at the end of systole (PWV-ES) of systole were analyzed. One-way analysis of variance (ANOVA) and least significant difference (LSD) tests were performed to compare cIMT, PWV-BS, and PWV-ES among subgroups in pairs. Pearson's correlation analysis, scatter plots, and subgroups correlation analysis were used to determine the relationships among ultrasound characteristics (cIMT, PWV-BS, PWV-ES), and major cardiovascular risk factors.

RESULTS

PWV-BS and PWV-ES for the early and advanced CKD groups were significantly higher than those for controls (all P<0.05). PWV-ES had the greatest correlation with age (r=0.474, P<0.001). PWV-ES had the greatest increase with age in the early CKD group (r=0.698, P<0.001).

CONCLUSIONS

ufPWV can be used for the quantitative evaluation of carotid stiffness in CKD patients. PWV-ES may be more advantageous in the assessment of carotid atherosclerosis in early CKD patients.

摘要

背景

慢性肾脏病（CKD）的死亡率和致残率与动脉粥样硬化性心血管事件的发生率高度相关。众多肾功能的临床生化指标往往仅在CKD晚期才升高，这迫切需要早期CKD中动脉粥样硬化的可靠指标。超快速脉搏波速度（ufPWV）可评估颈直动脉的僵硬度，并定量反映早期动脉粥样硬化程度。然而，ufPWV在CKD中的应用尚未见报道。在本研究中，我们旨在探讨用ufPWV量化的颈动脉僵硬度与CKD患者肾功能之间的关联。

方法

这项横断面研究于2017年3月至2022年5月在南京中医药大学附属医院共纳入582名参与者。其中，205名无CKD病史且估计肾小球滤过率（eGFR）≥90 mL/min/1.73 m²的个体被纳入对照组。根据美国肾脏基金会肾脏病预后质量倡议（K/DOQI）专家组对CKD的分期，44例1期和2期CKD患者被纳入早期CKD组，而49例3期、4期和5期CKD患者被纳入晚期CKD组。分析临床和血清参数、包括颈动脉内膜中层厚度（cIMT）在内的超声特征以及收缩期开始时的脉搏波速度（PWV-BS）和收缩期末尾的脉搏波速度（PWV-ES）。进行单因素方差分析（ANOVA）和最小显著差（LSD）检验以成对比较各亚组之间的cIMT、PWV-BS和PWV-ES。采用Pearson相关分析、散点图和亚组相关分析来确定超声特征（cIMT、PWV-BS、PWV-ES）与主要心血管危险因素之间的关系。