早期慢性肾病患者血管内皮功能及肾脏病理相关性研究

The research of endothelial function and renal pathology in early-stage chronic kidney disease(CKD) patient

目的:研究早期慢性肾病患者的血管内皮功能损害程度及其与肾脏病理损伤的关系。方法:60例研究对象分为3组:A组为20例正常对照组;B组为20例早期慢性肾病患者血压正常组;C组为20例早期慢性肾病患者肾性高血压组。对各组患者应用高频超声检测肱动脉充血前后管径变化率,评价早期慢性肾病患者血管内皮功能损害程度。对病例组行超声引导下穿刺活检,并对肾组织损伤程度行半定量积分,分析血管内皮功能与年龄、血压、肾脏病理损伤的关系。结果:①C组血流介导的血管舒张功能(Flow-mediated dilation,FMD)低于A组和B组(P<0.05),A组与B组之间FMD无差异性(P>0.05);②FMD与收缩压、肾小球损伤积分、肾间质损伤积分有相关性(P<0.05),与年龄、舒张压无相关性(P>0.05)。结论:①肾性高血压患者在肾功能损害之前已经存在血管内皮功能的异常;②血管内皮功能紊乱对肾脏的病理损伤有一定的促进作用;③高频超声早期检测慢性肾病患者的血管内皮功能有重要的临床意义。

Objective： To study the endothelial dysfunction in early-stage chronic kidney disease（CKD） patients and to ex- plore the relationship between Flow-Mediated Dilation （FMD） and renal pathology. Methods： Sixty subjects were divideded evenly into 3 groups： gronp A： normal control group; group B： renal patients without renal insufficiency; group C： renal hyper- tension patients without renal insufficiency. Each group underwent ultrasonographic examination of brachial artery diameter in the basic condition and the reactive hyperaemia. All renal patients had renal biopsy under ultrasound guidance. The degree of renal tissue damage made semiquantitative integral. We correlated endothelial function with age, pressure and renal pathology. Results： The FMD was impaired significantly in group C than that in group A and group B, but there was no difference in group A and group B; The FMD had a high correlation with systolic blood pressure, glomerular and interstitial damage index but no correlation with age and diastolic pressure. Conclusions： The endothelial function is impaired in renal hypertension patients without renal insufficiency; As the endothelial function becoming worse, renal pathological damage increased accordingly; Evaluation of the endothelial function by the high-resolution uhrasonography in early-stage CKD patients have c, linical improtance.