X线平片、脉搏波传导速度及踝肱指数在维持性血液透析患者血管钙化评价中的应用

摘要

Objective: To study the relationship between pulse wave velocity ( PWV) / ankle brachial index ( ABI) ant) different vascular calcification,and their predicting ability of vascular calcification in patients with maintenance hemodialysis (MHD). Methodology: One hundred and thirty one patients with MHD were enrolled in this study. The examination of X-ray was applied to diagnose vascular calcification. PWV and ABI were measured by non-invasive vascular screening device. Spearson analysis was applied to study the correlation between AB1/PWV and vascular calcification. Receiver operator characteristic(ROC) curve was applied to evaluate the sensitivity and specificity of diagnosis of vascular calcification by ABI/PWV.' Results: X-ray showed a positive correlation between peripheral and large vascular calcification score( P <0. 01). ABI was negatively correlated with general,large and peripheral vascular calcification score ( P < 0. 05). PWV was positively correlated with general and large vascular calcification score (P < 0. 05 ) except peripheral vascular calcification score. ROC curve revealed an AUC > 0. 5 for PWV and an ADC < 0. 5 for ABI in diagnosis of different vascular calcification. Conclusion: An intimate relationship between PWV/ABI and vascular calcification in MHD patients was demonstrated. PWV can be a screening index for vascular calcification especially for abdominal aorta calcification;but ABI could not apply successfully for vascular calcification diagnosis.%目的:评价维持性血液透析(MHD)患者脉搏波传导速度(PWV)、踝肱指数(AB1)与不同部位血管钙化的关系及其预测血管钙化的能力.方法:纳入四川省人民医院血液净化中心MHD患者131例,采用X线摄片评价血管钙化,无创性全自动动脉测量仪器测量患者的PWV及ABI.分别将不同部位血管钙化情况、血管钙化积分、PWV、ABI进行相关分析.将PWV 、ABI对诊断不同部位血管钙化进行受试者工作特征(ROC)曲线分析,评价其对诊断血管钙化的敏感性和特异性.结果:X线平片显示的外周及大动脉钙化积分之间呈正相关(P ＜0.01);ABI与整体钙化积分、大动脉钙化及外周动脉钙化积分之间均呈负相关(P ＜0.05)；PWV与整体钙化积分、大动脉钙化积分之间均呈正相关(P＜0.05),而与外周动脉钙化积分之间无显著相关.ROC曲线提示,对不同部位的血管钙化,PWV(ROC曲线下面积均＞0.5)均较ABI(ROC曲线下面积均＜0.5)有较好预测能力.结论:PWV及ABI与MHD患者整体及不同部位血管钙化关系密切,与ABI相比,PWV能够较好的预测MHD患者不同部位的血管钙化,ABI诊断血管钙化的能力不足.