摘要
目的了解终末期肾病(ESRD)患者肾血流动力学变化对血压控制的影响并探讨其机制。方法ESRD 患者按血压控制情况分为难治性高血压组和血压正常或控制良好组(对照组)。彩色多普勒超声检测患者肾血流动力学指标并判断有无肾动脉狭窄(RAS),测血总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]、氧化低密度脂蛋白(ox-LDL)和血清甲状旁腺素(PTH)水平,比较两组间肾血流动力学和临床指标的差异,通过 Logistic 回归分析了解难治性高血压与肾血流动力学和临床指标的关系。结果两组患者年龄、性别比例、透析时间、红细胞比容、血清尿素氮、肌酐、TC、TG、HDL-C、LDL-C、PTH、肾动脉舒张末期血流速度(EDV)和阻力指数(RI)均无差异,但难治性高血压组患者肾动脉收缩期峰值血流速度(PSV)、平均血流速度(MV)、搏动指数(PI)和肾动脉与腹主动脉最大血流速度比(RAR)显著低于对照组,其血清 Lp(a)和 ox-LDL 水平显著高于对照组。Logistic 回归分析显示 ESRD 患者难治性高血压的发生与肾动脉PSV、EDV、PI 和 RAR 水平显著相关,与其他血流动力学和临床指标无关。结论 ESRD 患者难治性高血压的发生与肾血流动力学的严重障碍、是否合并 RAS 及其严重程度密切相关。血脂代谢紊乱、尤其是 Lp(a)和 ox-LDL 水平升高可能是导致上述改变的主要原因。
Objective To investigate the relationship between refractory hypertension and renal hemodynamics in end stage renal diseases (ESRD) patients. Methods ESRD patients were classified into: patients with refractory hypertension (group A) and patients with normal blood pressure(group B). Renal hemodynamic indices were ex- amined by duplex ultrasonography. Fasting serum lipid (TC, TG, HDL-C, LDL-C, Lp(a), ox-LDL) and serum parathyroid hormane (PTH) were determined in all patients. Results Significant differences were found in renal hemodynamic indices such as peak systolic velocity (PSV), mean flow velocity (MV), pulsatility index (PI), renalaortic ratio (RAR) and in clinical index such as Lp(a) and ox-LDL between the two group. Refractory hypertension patients had lower renal hemodynamic indices and higher Lp(a) and ox-LDL levels than in patients with controlled BP. Logistic regression analysis revealed that refractory hypertension was related with PSV, EDV, PI and RAR, but not relevant with sex, age, dialysis time, hematocrit, BUN, creatinine, TC, TG, HDL-C, LDL-C, PTH, MV and RI. Conclusion Atherosclerotic renal artery stenosis and severe disorder in renal hemodynamics is likely the cause for refractory hypertention in ESRD patients. The rise of serum Lp(a) and ox-LDL might accelerate renal artery atherosclerosis.
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2008年第3期216-219,共4页
Chinese Journal of Hypertension
关键词
终末期肾病
难治性高血压
血脂
肾动脉狭窄
血流动力学
End stage renal disease
Refractory hypertension
Blood lipid
Renal artery stenosis
Hemodynamics