高频超声无创检测肾性高血压患者血管内皮功能的研究

High frenquency ultrasonography detection of endothelial function in patients with renal hypertension

目的评价肾性高血压患者血管内皮功能是否损害以及损害程度与肾功能的关系,以探讨高频超声检测肾性高血压患者血管内皮功能的临床价值。方法研究对象60例,分为4组。Ⅰ组:15例正常对照组;Ⅱ组:15例单纯肾性高血压组;Ⅲ组:15例氮质血症期肾性高血压组;Ⅳ组:15例尿毒症期肾性高血压组。各组分别于反应性充血前后及舌下含服硝酸甘油前后,应用高频超声检测肱动脉内径变化率,以此评价肾性高血压患者血管内皮功能是否受损以及损害程度与肾功能的关系。结果与正常对照组(Ⅰ组)相比,单纯肾性高血压组(Ⅱ组)内皮依赖性舒张功能已受损(P<0.05),而内皮非依赖性舒张功能无明显变化(P>0.05)。肾性高血压患者(Ⅱ组,Ⅲ组,Ⅳ组)反应性充血引起肱动脉内径变化百分数,三组比较有显著性差异(P<0.05)。含服硝酸甘油后肱动脉内径变化百分数,三组间比较无明显差异(P>0.05)。结论高分辨力超声可以早期检测肾性高血压患者血管内皮功能的改变;肾性高血压患者在肾功能损害之前已存在血管内皮功能异常;肾性高血压合并肾功能不全,且肾功能不全各期内皮功能受血压影响均衡时,血管内皮功能损害随肾功能损害加重而严重;高分辨力超声检测肾性高血压患者血管内皮舒张功能无创、简单、准确,对临床具有重要的应用价值。

Objective To evaluate the endothelial dysfunction in renal hypertension patients by the high-resolution ultrasound and to explore the relationship between Flow-Mediated Dilation （FMD） of the patients and renal function. Metheods Sixty patients were investigated in this study.The patients were divideded evenly into 4 groups： group I,healthy patients as control; group Ⅱ,renal hypertension patients without renal insufficiency; group Ⅲ, renal hypertension patients with azotemia; groupⅣ, renal hypertension patients with uremia.Every group underwent the ultrasonographic examination of brachial artery diameter in the baseline state and reactive hyperaemia after sublingual glyceryltrinitrate.And the relation between endothelium-depended dilation and renal function was also observed. Results There was significant difference of vessel diameter change between group Ⅰ and group Ⅱ.The endothelium-depended dilation was impaired significantly in group Ⅱ than that in control subjects （P〈0.05）,but there was no difference in endothelium independed dilation （P〉0.05）. At the same time,we also found that EDD in patients with uremia was less than that in patients with azotemia （P〈0.05）. In patients with azotemia,EDD was less than that in renal hypertension patients without renal insufficiency （P〈0.05）. But there was no difference in endothelium independed dilation （P〉0.05） among the three groups.Conclusion The endothelial function is impaired in renal hypertension patients and can be assessed non-invasively by measuring the EDD of the brachial arteries with high-resolution ultrasound. In renal hypertension patients without renal insufficiency, EDD has been impaired. As the renal function becoming worse, endothelial function of renal hypertension patients decreased according, when there is no diference in the levels of blood pressure. Evaluation of the endothelial function by the high-resolution ultrasonography in renal hypertension patients is simple,non-invasive and reliable and will be of great importance in clinic.