超声多普勒肾血流动力学测定对妊娠期高血压肾损害的研究

The study of renal circulation by color doppler ultrasonography on renal impairment caused by hypertensive disorders complicating pregnancy

目的 ：应用彩色超声多普勒观察妊娠期高血压患者肾动脉血流动力学的变化,探讨其在此病患者早期肾损害中的诊断价值。方法：选择南京医科大学附属南京妇幼保健院待产分娩的子痫前期患者40例（PE组）、慢性高血压并发子痫前期25例（慢高合并PE组）、妊娠合并慢性高血压21例（慢高组）、妊娠期高血压患者22例（GH组）和正常妊娠孕妇48例（正常妊娠组）为研究对象。于妊娠32~36周检测孕妇血肌酐（Scr）、血尿素氮（BUN）、血尿酸（UA）和肾小球滤过率（GFR）,同时采用彩色超声多普勒超声诊断仪对各组孕妇进行肾脏血流动力学检测。结果：1 PE组及慢高合并PE组中血BUN、UA明显高于正常妊娠组和慢高组（P〈0.05）;PE组Scr值明显高于慢高组、GH组及正常妊娠组,而GFR值明显低于这3组（P〈0.05）;2 PE组、慢高合并PE组和慢高组3组肾主动脉（MRA）及段动脉（SRA）的血流峰值加速时间（AT）明显高于正常妊娠组（P〈0.05）;GH组仅段动脉的血流峰值加速时间（AT）值高于正常妊娠组,而在主动脉此两组间AT值无差异;5组间MRA及SRA收缩期最大血流速度（Vs）、舒张期末血流速度（Vd）和阻力指数（RI）均无明显差异（P〉0.05）。结论：妊娠期高血压病时,子痫前期较慢性高血压所引起的肾损害更迅速、更严重。用肾脏超声多普勒测定各级肾动脉的AT是早期发现肾损害的敏感指标,其联合UA及GFR可为临床早期评价肾功能、制定治疗方案提供可靠依据。

Objective：Use color doppler ultrasonography to detect the blood flow alterations of renal artery in hypertensive disorders complicating pregnancy women for the purpose of early diagnosis of renal impairment. Methods：The research included 156 pregnant women chosen in Maternal-Child Health Centers affiliated to Nanjing Medical University. These women were classified into five groups：preeclampsia（PE,n=40）,chronic hypertension complicating preeclampsia（CHCPE,n=25）,chronic hypertension complicating pregnancy（CHCP,n=21）,gestational hypertension（GH,n=22）,normal pregnancy（NP,n=48）. In 32 to 36 gestational weeks,each woman＇s blood serum creatinine（Scr）,urea nitrogen（BUN）,uric acid（UA）,glomerular filtration rate（GFR）were tested and compared. At the same time,we use color doppler ultrasonography to detect the blood flow alterations of renal artery in these women. Results： 1In the PE and CHCPE group,the BUN and UA of the participants were significantly higher than that of the NP and CHCP groups.Compared with CHCP,GH and NP groups,the Scr of the participants in PE groups were significantly increased,while the GFR was markedly decreased（P〈0.05）. 2The acceleration times of main renal artery（MRA）and segmental artery（SRA）in PE,CHCPE and CHCP groups was remarkably higher than that in NP group（P〈0.05）. The acceleration times of SRA in GH group was significantly higher than that in NP group,while there was no difference of AT in MRA between the two groups. Also no difference of peak systolic velocity（Vs）,end diastolic velocity（Vd）and resistance index（RI）in MRA and SRA was found among the five groups（P〉0.05）.Conclusion：Renal impairment caused by preeclampsia was more quick and severe than that caused by chronic hypertension. AT of renal artery,checked by color doppler ultrasonography,was a sensitive indicator to detect renal impairment early. Using AT,combined with UAand GFR can provide a reliable basis for evaluation of renal function and formulation of treatment plan.