| Objective: The purpose of this study is to assess the level of arterialstiffness by detecting the functional change of carotid and radial arterialelasticity in Chronic Kidney Disease patients, and to investigate the correlativefactors of arterial elasticity, so we can provide methods and evidences forclinical early diagnosis and treatment.Methods:1Selected70CKD hospitalized patients as cases that werediagnosed in Hebei Medical University from february2010to february2012,36males and34females in it, from19years old to77years old. The mean agewas48.33±16.76years, among which there were38patients havingprotopathy of chronic glomerulonephritis,11patients of diabetic nephropathy,9patients of hypertensive nephropathy,3patients of ADPKD,1patient ofAristolochic acid nephropathy,1patients of Chronic pyelonephritis, and7patients of unknown causes. Selection criteria were: to comply with thediagnosis standard of Chronic Kidney Disease in K/DOQI, above18years old,having not haemodialysis, agreeing to attend the study. Exclusion criteria were:malignant tumor, presence of acute inflammation, serious liver disease orliver injury, serious coronary heart disease or arrhythmia,acute renal failure,established peripheral vascular diseases. The patients were divided into3groups according to the international common clinical staging standards (K/DOQI) basing on the life quality of CKD patients: A group having20patientsis CKD stage1, B group having20patients is CKD stage2-4, C group having30patients is CKD stage5. The control group included30healthy cases in thesame period,17males and13females in it, from26years old to79years old.The mean age was43.00±15.08years old, excluding the people who haddiabetesmellitus,hypertension,coronaryheartdisease,hyperlipidemia, peripheralvascular diseases, and so on. 2With vascular echo-tracking(ET)technology of ALOKA α-10Color Doppler ultrasound, detected the arterial elastic parameters of left common carotid artery(CCA)and left radial artery(RA)of case group and control group:Stiffness parameter(β), vascular pressure-strain elasticty modulus(Ep), arterial compliance(AC), augmentation velocity index(AI), one-point pulse wave velocity(PWVβ). Simultaneously,detected the serum calcium(Ca), serum phosphorus(P), serum creatinine(Scr), blood urea nitrogen(BUN), serum albumin level(ALB), total cholesterol(CHOL), triglyceride(TG), highdensity lipoproteins(HDL), C-reaction protein(CRP) in early morning onanempty stomach, accounting glomerular filtration rate(GFR) and calcium-phosphorus product(Ca*P).3SPSS13.0software was adopted to conduct Statistical analysis on therecorded data, with numerous data presented as mean±standard deviation(SD).To compare the mean values of the multigroup we used the one-way analysisof variance(ANOVA)method. Linear regression analysis was undertaken todetermine the correlation between variables in univariate analyses. Multiplelinear regression analysis was undertaken to determine the correlation betweenvariables in multifactor analyses. P<0.05was considered statisticallysignificant.Results:1The comparison of common carotid artery elastic parameters ineach group of the case group and the control group: the β,PWVβ,EP,AC,AI of control group was respectively5.16±2.13,5.27±1.33m/s,84.30±26.74KPa,1.03±0.30mm2/KPa,11.48±15.58%. The β, PWVβ, EP, AC,AI ofA group was respectively6.60±2.66,5.66±0.91m/s,95.17±40.85KPa,1.00±0.33mm2/KPa,7.03±12.02%. The β, PWVβ, EP, AC, AI of B groupwas respectively8.33±3.67,7.92±1.44m/s,118.96±51.65KPa,0.76±0.43mm2/KPa,11.58±12.42%. The β, PWVβ, EP, AC, AI of C group was res-pectively11.06±4.45,10.37±1.37m/s,162±63.96KPa,0.68±0.32mm2/KPa,10.63±2.75%. The β had statistically significant between B group, C gro-up and control group(P<0.05). PWVβ had statistically significant betwee -n B group, C group and control g-roup,and among A group, B group,C group(P<0.05). EP had statistically significant between A group andC group, B group and C group, C group and control group (P<0.05).AC, AI had not statistically significant among each group(P>0.05).2The comparison of radial artery elastic parameters in each group ofthe case group and the control group: the β, PWVβ, EP, AC, AI of controlgroup was respectively10.26±3.79,7.26±1.79m/s,194.17±89.83KPa,0.17±0.26mm~2/KPa,-0.39±29.24%. The β, PWVβ, EP, AC, AI of Agroup was respectively13.62±4.75,8.75±1.89m/s,208.40±82.69KPa,0.07±0.04mm~2/KPa,-12.88±16.71%. The β, PWVβ, EP, AC, AI of B groupwas respectively17.81±4.9,9.93±1.53m/s,251.71±97.18KPa,0.06±0.04mm~2/KPa,1.46±0.53%. The β, PWVβ, EP, AC, AI of C group wasrespectively23.44±4.79,10.93±2.85m/s,342.96±98.84KPa,0.04±0.03mm2/KPa,1.24±23.16%. The β had statistically significant betweenA group and B group, A group and C group, A group and control group, Bgroup and control group, C group and control group(P<0.05). PWVβ hadstatistically significant between A group and C group, A group and controlgroup, B group and control group, C group and control group(P<0.05). EP hadstatistically significant between A group and C group, B group and C group, Bgroup and control group, C group and control group(P<0.05). AC hadstatistically significant between A group and case group, B group and casegroup, C group and control group(P<0.05). AI had not statistically significantamong each group(P>0.05).3The correlation of each artery elastic parameter of CCA and eachclinical marker in case group: There was a significant positive correlationbetween β and calcium-phosphorus product, total cholesterol, C-reactiveprotein (r=0.432, P=0.017; r=0.451, P=0.012; r=0.534, P=0.030). Asignificant negative correlation was seen between β and glomerular filtrationrate, high density lipoproteins, albumin (r=-0.389,P=0.035; r=-0.416,P=0.039; r=-0.454,P=0.029). There was a significant positive correlationbetween PWVβ and total cholesterol, calcium-phosphorus product, triglyceride (r=0.482, P=0.007; r=0.463, P=0.013; r=0.476, P=0.014). Asignificant negative correlation was seen between PWVβ and high densitylipoproteins, glomerular filtration rate, albumin (r=-0.590, P=0.026; r=-0.553, P=0.002; r=-0.433, P=0.027). There was a significant positivecorrelation between EP and calcium-phosphorus product, total cholesterol (r=0.416,P=0.038；r=0.419,P=0.030). A significant negative correlation wasseen between EP and glomerular filtration rate (r=-0.604, P=0.022).Following multi-linear regression analysis,significant associations were seenbetween βand glomerular filtration rate, calcium-phosphorus product, totalcholesterol (Beta=-0.325, P<0.05; Beta=0.294, P<0.05; Beta=0.537, P<0.01),between PWVβ and glomerular filtration rate, calcium-phosphorus product,triglyceride (Beta=-0.638, P<0.05; Beta=0.446, P<0.05; Beta=0.729,P<0.05),between EP and calcium-phosphorus product (Beta=0.721,P<0.05).4The correlation of each artery elastic parameter of RA and eachclinical marker in case group: There was a significant positive correlationbetween β and C-reactive protein, triglyceride, calcium-phosphorus product(r=0.495, P=0.027; r=0.660, P=0.000; r=0.533, P=0.002). A significantnegative correlation was seen between β and glomerular filtration rate,albumin (r=-0.495, P=0.010; r=-0.483, P=0.017). There was a significantpositive correlation between PWVβ and triglyceride, total cholesterol,C-reactive protein (r=0.744,P=0.000; r=0.585, P=0.001；r=0.483,P=0.019).A significant negative correlation was seen between PWVβ and glomerularfiltration rate, albumin (r=-0.470,P=0.012; r=-0.432, P=0.025). There was asignificant positive correlation between EP and calcium-phosphorus product,C-reactive protein, triglyceride, total cholesterol (r=0.511,P=0.009; r=0.589,P=0.016； r=0.565, P=0.006； r=0.455, P=0.019). A significant negativecorrelation was seen between EP and glomerular filtration rate, albumin (r=-0.521, P=0.009; r=-0.542, P=0.006). Following multi-linear regressionanalysis,significant associations were seen between β and C-reactive protein,glomerular filtration rate (Beta=0.495, P<0.05; Beta=-0.337, P<0.05),between PWVβ and glomerular filtration rate (Beta=-0.307, P<0.05), between EP and calcium-phosphorus product, glomerular filtration rate(Beta=0.598, P<0.05; Beta=-0.385, P<0.05).Conclusion:1With the progression of renal function,the vascular of CCA and RAis becoming hardening.The β, EP and PWVβ value is increasing and AC valueis decreasing. AI has not apparente regularity. Detecting elasticity parametersof RA is more pristinely and more susceptibly than detecting elasticityparameters of CCA to reflex the alteration of vascular elasticity.2It is an independent risk factor of glomerular filtration rate,calcium-phosphorus product, total cholesterol and triglyceride for the stiffnessof CCA. It is an independent risk factor of glomerular filtration rate,calcium-phosphorus product and C-reactive protein for the stiffness of CCA.We should prevent the factors actively in the early stage of CKD, to defer theprogression of arterial stiffness. |
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