妊娠高血压疾病患者肾血流动力学与血管内皮功能的相关性研究

Correlation of renal hemodynamics and vascular endothelial function in patients with hypertensive disorders in pregnancy

目的应用彩色多普勒超声分析妊娠高血压疾病(HDP)患者肾动脉血流动力学与血管内皮功能的相关性。方法将80例HDP患者按照病情分为妊高组(妊娠期高血压,26例)、轻度PE组(轻度子痫前期,28例)与重度PE组(重度子痫前期,26例),并选取正常妊娠者30例为对照组。采用彩色多普勒超声测定肾叶间动脉阻力指数(RI)、搏动指数(PI)、收缩期流速峰值(PSV)、舒张末期流速峰值(EDV)、和S/D值,并检测患者的血清内皮素(ET-1)以及一氧化氮(NO)水平。结果 (1)ET-1、NO的单因素方差分析结果差异均有显著统计学意义(P<0.01),HDP患者的ET-1水平显著高于对照组(P<0.01),其NO水平显著低于对照组(P<0.01),且随着HDP加重ET-1水平升高、NO水平降低。(2)RI、PI、EDV和S/D的单因素方差分析结果差异均有显著统计学意义(P<0.05),轻度与重度PE组的RI、PI和S/D显著高于对照组(P<0.05),而轻度与重度PE组的EDV显著低于对照组(P<0.05)。(3)HDP患者肾叶间动脉RI、PI、S/D与血清ET-1呈显著正相关(P<0.01),与NO呈显著负相关(P<0.01)。结论经彩色多普勒超声测定的肾血流动力学指标与血管内皮功能的ET-1、NO之间相关,并且其测量的肾血流动力学指标能够反映出HDP患者血流变化以及肾脏损害。

Objective To explore the correlation between renal hemodynamics and vascular endothelial func-tion in patients with hypertensive disorders in pregnancy （HDP） through color Doppler ultrasonography. Methods 80 cases of HDP patients were divided into gestational hypertension group （26 cases）, gently preeclampsia group （28 cases） and severe preeclampsia group （26 cases） according to their condition and 30 cases of normal pregnancy women were chosen as the control group. The resistive index （RI）, pulsatility index （PI）, peak systolic velocity （PSV）, the end dia-stolic velocity （EDV） and S/D of renal interlobar artery were tested by Color Doppler ultrasonography. Meanwhile, the 1evels of serum endothelin-1 （ET-l） and nitric oxide （NO） were examined. Results （1） The One-way ANOVA of ET-1 and NO were significantly different （P〈0.01）. The level of serum ET-1 in patients with HDP were significantly higher than that in the control group （P〈0.01） and serum NO in patients with HDP were lower than that in the control group （P〈0.01）. The level of serum ET-1 increased and level of serum NO reduced along with the exacerbation. （2） The One-way ANOVA of RI, PI, EDV and S/D were significantly different （P〈0.05）. The levels of RI, PI, S/D in pre-eclampsia patients were significantly higher than that in the control group （P〈0.05）. The Level of EDV in preeclamp-sia patients were significantly lower than that in the control group （P〈0.05）. （3） The RI, PI and S/D of renal interlobar artery was significantly positively related to the level of serum ET-1 （P〈0.01） and was negatively related to the level of serum NO （P〈0.01）. Conclusions The renal hemodynamics evaluated by color Doppler ultrasonography correlat-ed to serum ET-1 and NO in endothelial function and could reflect the changes of renal hemodynamics and renal dam-age in HDP patients.