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目的探讨速度向量成像技术(VVI)对慢性肾脏病(CKD)患者及高血压患者颈总动脉弹性与舒缩非同步性评估的临床价值。方法以中度CKD合并高血压患者(CKD组)、年龄和性别匹配的原发性高血压患者(EH组)及健康人群为研究对象,收集上述人群的临床和生化检查数据。采用VVI技术,分析颈总动脉短轴6节段径向速度、环向应变和环向应变率(SR)、径向速度达峰时间(Tv)及其标准差(SD-Tv)、环向应变达峰时间(Ts)及其标准差(SD-Ts)、SR达峰时间(Tsr)及其标准差(SD-Tsr)等弹性及同步性指标进行分析。结果 3组间颈总动脉内膜中层厚度(IMT)差异无统计学意义。CKD组环向应变明显低于对照组;径向速度、SR、Tv、Ts和Tsr三组间差异无统计学意义。SD-Tv[(35.74±7.87)比(22.67±5.36)比(10.52±2.93)ms,均P<0.05]、SD-Ts[(159.54±31.62)比(134.81±25.95)比(63.15±13.57)ms,均P<0.05]、SD-Tsr[(41.67±15.72)比(30.54±10.85)比(18.61±5.93)ms,均P<0.05]在CKD组及EH组均增加,但CKD组增加更显著。另外,颈总动脉径向速度曲线、环向应变曲线及SR曲线在CKD组及EH组离散程度大,管壁各点同步性差。结论 VVI技术可早期评估CKD患者及高血压患者亚临床血管病变。颈动脉发生IMT增厚及弹性改变前,已出现非同步性舒缩。
Objective To investigate the clinical value of velocity vector imaging (VVI) in the assessment of the non-synchronicity of common carotid artery elasticity and systole in patients with chronic kidney disease (CKD) and hypertension. Methods The data of clinical and biochemical examinations were collected from moderate CKD patients with hypertension (CKD group), age and sex matched essential hypertension (EH group) and healthy subjects. VVI technique was used to analyze radial velocity, circumferential strain and circumferential strain rate (SR), radial velocity peak time (Tv) and standard deviation (SD-Tv) (Ts) and its standard deviation (SD-Ts), SR peak time (Tsr) and its standard deviation (SD-Tsr) and other elastic and synchronization indicators were analyzed. Results There was no significant difference in carotid artery intima-media thickness (IMT) between the three groups. The circumferential strain in CKD group was significantly lower than that in control group; there was no significant difference in radial velocity, SR, Tv, Ts and Tsr between the three groups. SD-Tv was significantly higher than that of SD-Tv [(35.74 ± 7.87) vs (22.67 ± 5.36) vs (10.52 ± 2.93) ms, P <0.05] ms, P <0.05], and the values of SD-Tsr [(41.67 ± 15.72) vs (30.54 ± 10.85) vs (18.61 ± 5.93) ms, all P <0.05] increased in CKD and EH groups Significant. In addition, the common carotid artery radial velocity curve, circumferential strain curve and SR curve in the CKD group and EH group dispersion degree, the tube wall synchronization is poor. Conclusion The VVI technique can be used to evaluate subclinical vascular lesions in CKD patients and hypertensive patients. Astigmatism and asystole have occurred before carotid IMT thickening and elastic changes.