原发性高血压与糖尿病早期肾损伤的临床比较

Clinical Comparisons of Early Renal Injury in Essential Hypertension and Diabetes Mellitus

为进一步探讨原发性高血压病和非胰岛素依赖型糖尿病病程中早期肾脏损害的临床特点及防治对策,对原发性高血压病人36例,非胰岛素依赖型糖尿病14例进行肾功能的生化及双核素肾动态显影部分指标测定.结果显示,高血压组经代偿和药物调节等因素影响,其血清肌酐增高,肾小球滤过率(GFR)降低(与糖尿病组比较,P值均<0.05)的同时,肾小球滤过分数(FF)、出球小动脉阻力(RE)改变不明显.糖尿病组早期主要表现为有效肾血流量(ERPF)、GFR、FF、RE增高,其中以GFR增高最为明显,P值<0.05.显示高血压病和糖尿病早期肾损害均主要是血液动力学方面的改变.虽然启动因素不同,但肾小球内高压是致肾损害的重要共同环节.故应强调在对高血压,糠尿病进行全身治疗的同时,重视对肾脏血液动力学方面的合理调节.

To further investigate clinical feature and tack of early renal injury in the patients with hypertension and diabetes. Renal biochemical and radionuclide parameters were assessed in 36 essential hypertensive and 14 diabetic subjects. Elevated serum creatinine level, and declined glomerular filtration rate (GFR) were found in hypertensives (P<0. 05). In diabetic group, the parameters for GFR, effective renal plasma flow (ERPF), filtration fraction (FF), and efferent arteriolar resistance (RE) all were elevated. Among these parameters, increased GFR was more prominant (F<0. 05) as compared with hypertension. The results suggest that early renal injury present the hemodynamic alterations mainly. Infra-glomerular hypertension is a important factor to renal lesion for both hypertension and diabetes. It is necessary to emphasize that reasonable administration to renal hemodynamics should be take into consideration along with the systemic therapy.