维持性血液透析患者降脂治疗对颈动脉硬化斑块的干预性研究

摘要

Objective To study the changes of carotid atherosclerotic plaques in maintenance hemodialysis patients after lipid-lowering therapy, and to provide guidance for clinical prevention and treatment carotid atherosclero-sis in patients underwent maintenance hemodialysis. Methods 136 cases of hemodialysis patients were selected and randomly divided into treatment group and control group. The control group used dialysis and other conventional treat-ments, and the treatment group used cholesterol-lowering drugs (sodium fluoride cut statin) with 40 mg/d in addition to the treatment in the control group. The changes of carotid plaques and the related parameters of hematology after 12 months treatment and ultrasonic testing in the two groups were compared. Results After treatment, the carotid artery plaque area and carotid intima-in the film thickness (CIMT) were statistically significantly decreased in the treatment group, compared to those before treatment (P<0.05). There were no statistically significant difference in carotid artery plaque area and thickness of CIMT in the control group between before and after treatment. Comparison the carotid ar-tery plaque area and thickness of CIMT in the two groups after treatment showed that the carotid artery plaque area and thickness of CIMT decreased there were statistically significant difference. In treatment group, TC, triglyceride (TG), low density lipoprotein cholesterol (LDL-C), blood urea nitrogen, high blood viscosity and low shear viscosity were decreased at different degrees, and high-density lipoprotein cholesterol (HDL-C) was statistically significant in-creased after treatment (P<0.05). In control group, only the urea nitrogen showed statistically significant decreased af-ter treatment, compared to that before treatment (P<0.05). After treatment, TC, TG, LDL-C, high bloodviscosity, low-er blood viscosity of the treatment group were statistically significantly lower than those in the control group, while HDL-C the treatment group were statistically significantly higher than that in the control group (P<0.05). There was no significant difference in blood urea nitrogen between the two groups after treatment (P>0.05). Conclusion Carot-id artery plaque area and thickness of CIMT in maintenance hemodialysis patients are significantly reduced, and lipid levels and blood rheological index are significantly improved after the lipid-lowering therapy, which is conducive to the prognosis of patients.%目的：研究维持性血液透析性患者进行降脂治疗后颈动脉硬化斑块的变化情况，为临床上需进行血液透析的患者预防和治疗颈动脉硬化提供指导意见。方法选取在我科进行治疗的血液透析的患者136例随机分为治疗组和对照组，对照组患者采用透析等常规方法治疗，治疗组在对照组基础上施加降血脂类药物(氟伐他汀钠)40 mg/d，治疗12个月后超声检查比较两组颈动脉斑块变化及各血液学相关指标的变化情况。结果治疗组患者治疗前后颈总动脉斑块面积和颈动脉内膜-中膜厚度(CIMT)进行比较，其差异均具有统计学意义(P<0.05)，颈动脉斑块面积明显减小、CIMT厚度减小；对照组治疗前后颈动脉斑块和CIMT厚度进行比较，其差异无统计学意义(P>0.05)；治疗后两组患者分别进行颈总动脉斑块面积和CIMT厚度比较，结果显示，治疗组颈动脉斑块面积明显减小、CIMT厚度明显减小，其差异均具有统计学意义(P<0.05)；治疗组治疗后(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、尿素氮、高血切黏度、低血切黏度均不同程度的降低，高密度脂蛋白胆固醇(HDL-C)治疗后升高明显，差异均具有统计学意义(P<0.05)；对照组治疗前后仅尿素氮呈降低趋势，差异具有统计学意义(P<0.05)；治疗后治疗组的TC、TG、LDL-C、高血切黏度、低血切黏度均低于对照组，HDL-C高于对照组，差异均有统计学意义(P<0.05)；两组间血尿素氮治疗后差异无统计学意义(P>0.05)。结论对维持性血液透析性患者进行降脂治疗后患者的颈动脉斑块面积、CIMT厚度明显减小，血脂水平、血液流变学指标明显好转，有利于患者的预后。