肾阻力指数检测对正常血压和高血压病患者慢性肾小管间质损害的临床研究

Relationship between renal resistive index and chronic tubulointerstitial nephropathy in normo-and hypertensive patients

目的研究肾叶间动脉阻力指数(RI)检测在评价正常血压和高血压患者并发慢性肾小管间质损害(CTIN)程度的临床价值。方法入选36例正常血压及38例高血压病患者,所有患者均有潜在CTIN病史,但肾功能正常,通过ELISA法测定尿视黄醇结合蛋白(RBP)、酶-底物直接显色法测定,尿N-乙酰-β-氨基葡萄糖苷酶(NAG酶)及尿液浓缩酸化试验判断肾小管功能。将入选的患者再分为有CTIN和无CTIN 2组。35例健康者作为正常对照。采用多普勒超声测定肾脏叶间动脉RI及其他肾脏参数。双肾ECT测定肾小球滤过率(GFR)。结果有CTIN正常血压及高血压患者叶间动脉RI较无CTIN及正常对照组均明显升高(P<0.05);RRI与有潜在CTIN正常血压及高血压患者的RBP和NAG酶、尿酸分别呈明显正相关。结论在肾功能正常情况下,多普勒超声测定肾叶间动脉RI可早期发现高血压和正常血压患者并发的CTIN,对判断预后并行干预治疗具有一定的临床意义。

Objective To explore the relationship between renal resistive index（RRI） and chronic tubulointerstitial nephropathy（CTIN） in normo-and hypertensive patients.Methods Thirty-six normotensive and 38 hypertnsive patients with a clinical history suggestive of CTIN but normal renal function.Serum levels of retinol binding protein（RBP）,n-acetyl-β-d-glucosaminidase（NAG） were detected by enzyme linked immunosorbent assay（ELISA）.Patients were considered CTIN-negative or CTIN-positive after being investigated of tubular function by urine concentrating and acidification tests.Thirty-five cases of healthy volunteers served as controls.Renal sonographic parameters and RRI were obtained by duplex scanner.Glomerular filtration rate（GFR） was investigated by renal ECT.Results RRI values of CTIN-positive normotensive and hypertensive patients were significantly higher than those of CTIN-negative and of controls（P0.05 for both）.RRI values were linearly related to the level RBP,NAG and uricemia in normotensive and hypertensive patients with CTIN.Conclusion RRI measurement allows the early identification of both normotensive and hypertensive patients with CTIN and signs of tubular dysfunction,when renal function is still preserved.