妊娠高血压患者肾血流动力学与血管内皮功能的相关性研究

Relevance study of renal hemodynamic change and endothelia dysfunction in patients with hypertensive disorder complication pregnancy

目的探讨妊娠高血压疾病（HDCP）患者内皮素-1（ET-1）和一氧化氮（NO）对肾动脉血流动力学的影响及肾血流动力学改变在妊娠高血压诊断中的应用价值。方法妊娠高血压患者56例，其中妊娠期高血压组（GH）18例，轻度子痫前期组（轻度PE）18例，重度子痫前期组（重度PE）20例；正常妊娠者20例为对照组。应用彩色多普勒超声测量肾叶间动脉收缩期峰值流速（PSV）、舒张末期流速（EDV）、阻力指数（RI）、搏动指数（PI）等指标，同时检测血清ET-1和NO浓度。结果轻度及重度PE组EDV低于正常妊娠组，差异有统计学意义（P〈0．05）。轻度及重度PE组RI、PI、S／D值均高于正常妊娠组，差异有统计学意义（P〈0．05）。妊娠高血压疾病患者血清ET-1水平高于正常妊娠组，且随病情的加重ET-1水平升高，差异有统计学意义（P〈0．01）；妊娠高血压患者血清NO水平低于正常妊娠组，且随病情的加重N0水平降低，差异有统计学意义（P〈0．01）。妊娠高血压疾病患者肾叶间动脉S／D、RI、PI与血清ET-1呈正相关（P〈0．05），与血清NO呈负相关（P〈0．01）。结论彩色多普勒超声测量的肾血流动力学参数是反映HDCP患者血流变化和肾脏损害的敏感指标，与反映血管内皮功能的细胞因子ET-1和NO有良好的相关性。

Objective To investigate if the endothelin-1 （ET-1）, nitric oxide（NO） can affect renal artery blood flow and explore the clinical value of ultrasonography in hypertensive disorder complication pregnancy. Methods 18 patients of gestational hypertension,IS patients of gently preeelampsia,20 patients of severe preeclampsia and 20 normal pregnancy women were chosen in random. Color Doppler uhrasonography was used to detect the peak systolic velocity （PSV）,end diastolic velocity （EDV）,resistive index （RI）, pulsatility index （PI） of renal interlobar artery. The levels of serum ET-1 and NO were measured by enzyme linked immunosorbent assay （ELISA） and nitric acid recovery respectively. Results The level of EDV in preeclampsia patients were significant lower than the control group （ P〈0.05）. The levels of RI,PI,S/D in preeclampsia patients were significant higher than the control group （P〈0.05）. The level of ET-1 in study group was higher than control group （ P 〈0. 01）. The level of NO in study group was lower than control group （ P〈0.01 ）. There was positive correlation between the RI, PI, S/D of renal interlobar artery and the level of serum ET-1. There was inverse correlation between the RI,PI,S/D of renal interlobar artery and the level of serum NO. Conclusions Endothelial dysfunction can cause unbalance of renal vessel systolic-diastolic function. The level of renal artery blood flow parameters can reflect the state of vessel function and have clinical value in hypertensive disorder complication pregnancy.