高血压病患者颈总动脉彩色多普勒超声与肾小动脉病理改变的相关性研究

Study on correlation between common carotid artery Color Doppler ultrasound and reno-arteriolar pathological changes in hypertension patients

目的应用彩色多普勒超声研究高血压病患者颈总动脉超声与肾小动脉病理改变的相关性。方法研究对象包括50例健康体检无高血压且肾功能正常(A组),100例高血压病伴肾功能下降,根据K/DOQI指南对慢性肾脏病(CKD)的分期标准2期50例(B组),3期50例(C组)。常规行颈动脉彩色多普勒超声检查,测量颈总动脉和颈动脉分叉处平均内中膜厚度(IMT)最大值(CBMmax)、颈总动脉(CCA)收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI),三组测量结果进行对比分析。B、C两组行肾组织活检,对比病理诊断肾小动脉硬化结果。结果 A、B、C三组间两两比较,CBMmax与肾损害程度成正比(P<0.001);CCA-PSV、CCA-EDV、CCA-RI各组间有统计学差异(P<0.01～0.001)。B组CCA-PSV、CCA-EDV明显高于其他两组(P<0.001),C组则相反(P<0.001);B组、C组CCA-RI均高于对照组(P<0.001),C组CCA-RI高于B组(P<0.01)。B、C两组肾活检病理诊断肾小动脉硬化的结果分析(P<0.001),说明高血压病患者肾小动脉硬化的发病率随肾功能损害的加重而增高。结论彩色多普勒超声可通过颈总动脉和颈动脉分叉处平均IMT最大值(CBMmax)、颈总动脉血流动力学指标反映高血压病患者大动脉粥样硬化程度,对早期判断高血压病伴肾功能下降、肾小动脉硬化具有重要意义。

Objective The aim of the study was to research the correlation between common carotid artery Color Doppler ultrasound and reno-arteriolar pathological changes in hypertension patients.Methods The subjects including 50 non-hypertension healthy adults with normal renal function(A group),100 hypertension patients with renal decline,they were divided into 2 groups according to the Kidney Disease Outcomes Quality Initiative(K/DOQI)stage 2-3 chronic kidney disease:50 cases of them in stage 2(B group),50 cases of them in stage 3(C group).Using Color Doppler ultrasound to exam the mean max intima-media thickness of common carotid artery and carotid bifurcation(CBMmax).Parameters of common carotid artery(CCA)were measured,including peak systolic velocity(PSV),end-diastolic velocity(EDV)and resistance index(RI).The results of our research were compared among 3 groups.The results were compared on reno-arteriolar sclerosis pathological diagnosis which got by renal tissue biobsy between B and C groups.Results CBMmax were proportional with renal damage by pairwise comparison among the 3 groups(P<0.001);Significant differences were seen about CCA-PSV、CCA-EDV and CCA-RI among the 3 groups.CCA-PSV、CCA-EDV in B group were significantly higher than the other groups,the compared result of C group was the opposite(P<0.001);CCA-RI in B and C group were significantly higher than the control group(P<0.001),CCA-RI in C group was higher than B group(P<0.01)。Analysis on results of reno-arteriolar sclerosis pathological diagnosis between B and C groups(χ2=14.4385,P<0.001)showed that incidence rate of reno-arteriolar sclerosis was increased with renal damage in hypertension patients.Conclusion Common carotid artery hemodynamic indexes and CBMmax could reflect the extent of large-artery atherosclerosis in hypertension patiens by Color Doppler ultrasound.It has great significance to early diagnosis hypertension patients with renal decline and reno-arteriolar sclerosis.