| Research background and purpose:Chronic kidney disease(CKD)has become a serious challenge to the global health care system.Cardiovascular disease(CVD)is the first cause of death in CKD patients.Atherosclerosis(AS)is the pathological basis of cardiovascular disease.Its pathogenesis is complex.Endothelial dysfunction and decreased exercise ability can lead to the occurrence and development of AS.Enhanced external counterpulsation(EECP)is a safe and noninvasive device for cardiopulmonary bypass.EECP can prevent the occurrence of CVD events by increasing the shear stress of endothelium,reducing the deposition of harmful substances on the endothelial cells,improving the endothelial function of blood vessels to achieve anti AS and improve the movement ability of patients.The therapeutic effect of EECP on CVD has been widely recognized at the world,but there are few studies on cardiovascular disease intervention in patients with chronic kidney disease.The purpose of this study is to observe the changes of carotid intima-media thickness(c IMT),6-minute walking test,Borg’s scale,serum homocysteine(Hcy),C-reactive protein(CRP),nitric oxide(NO),plasma viscosity before and after EECP treatment,to dicuss the mechanism of EECP on anti AS and improving exercise ability,so as to provide a new intervention idea for CKD patients to prevent CVD.Materials and Methods:Patients with 2-4 stage CKD patients with single stable carotid atherosclerotic plaque were selected from Nephrology Department of the First Affiliated Hospital of Chengdu Medical College.64 patients were randomly divided into EECP group(32cases)and Conventional treatment group(32 cases).The Conventional treatment group was given conventional drug treatment,and EECP group was given EECP treatment on the basis of conventional treatment.EECP was treated 1/day,60 min/time,5/week for 8weeks.The changes of c IMT,6-minute walking test,Borg’s scale,Hcy,CRP,NO and plasma viscosity were compared before and after treatment.30 healthy people were selected as the Healthy control group without any treatment.Serum Hcy,CRP,NO and plasma viscosity were measured before the study and compared with those of CKD patients with CAS.Results:1.The baseline conditions(gender,age,BMI,smoking history,diabetes,hypertension,hyperlipidemia,TG,TC,HDL-C,LDL-C and medication history)of EECP group and Conventional treatment group were not statistically significant and comparable.2.Before treatment,there was no significant difference in cIMT between EECP and Conventional treatment group(P > 0.05);after treatment,c IMT of EECP group and Conventional treatment group decreased significantly(P < 0.05);after treatment,c IMT of EECP group was lower than Conventional treatment group,and the difference was statistically significant(P < 0.05).6-minute walking test’s distance of 2-4 stage CKD patients with CAS was significantly shorter than Healthy control group(P < 0.05).Before treatment,there was no significant difference in 6-minute walking test’s distance between EECP and Conventional treatment group(P > 0.05);after treatment,6-minute walking test’s distance of EECP group and Conventional treatment group increased significantly(P < 0.05);after treatment,6-minute walking test’s distance of EECP group was longer than Conventional treatment group,and the difference was statistically significant(P < 0.05).Borg’s scale score of 2-4 stage CKD patients with CAS was significantly higher than Healthy control group(P < 0.05).Before treatment,there was no significant difference in Borg’s scale score between EECP and Conventional treatment group(P > 0.05);after treatment,Borg’s scale score of EECP group and Conventional treatment group decreased significantly(P < 0.05);after treatment,Borg’s scale score of EECP group was lower than Conventional treatment group,and the difference was statistically significant(P < 0.05).3.Hcy level of 2-4 stage CKD patients with CAS was significantly higher than Healthy control group(P < 0.05).Before treatment,there was no significant difference in Hcy level between EECP and Conventional treatment group(P > 0.05);after treatment,Hcy level between EECP and Conventional treatment group was lower than before treatment(P < 0.05);after treatment,Hcy level of EECP group was lower than Conventional treatment group,and the difference was statistically significant(P < 0.05).CRP level of 2-4 stage CKD patients with CAS was significantly higher than Healthy control group(P < 0.05).Before treatment,there was no significant difference in CRP level between EECP and Conventional treatment group(P > 0.05);after treatment,CRP level between EECP and Conventional treatment group was lower than before treatment(P < 0.05);after treatment,CRP level of EECP group was lower than Conventional treatment group,and the difference was statistically significant(P < 0.05).NO level of2-4 stage CKD patients with CAS was significantly lower than Healthy control group(P< 0.05).Before treatment,there was no significant difference in NO level between EECP and Conventional treatment group(P > 0.05);after treatment,NO level between EECP and Conventional treatment group was higher than before treatment(P < 0.05);after treatment,NO level of EECP group was higher than Conventional treatment group,and the difference was statistically significant(P < 0.05).Plasma viscosity of 2-4 stage CKD patients with CAS was significantly higher than Healthy control group(P < 0.05).Before treatment,there was no significant difference in plasma viscosity between EECP and Conventional treatment group(P > 0.05);after treatment,plasma viscosity between EECP and Conventional treatment group was lower than before treatment(P < 0.05);after treatment,plasma viscosity of EECP group was lower than Conventional treatment group,and the difference was statistically significant(P < 0.05).Conclusions:1.EECP can reduce the thickness of carotid atherosclerotic plaque in 2-4 stage CKD patients and delay the development of AS,which may be through reducing content of Hcy and CRP in serum,increasing content of NO and improving vascular endothelial function;2.EECP can improve the exercise ability of 2-4 stage CKD patients with CAS. |
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