动态动脉硬化指数与超声造影评估早期高血压肾损伤

Evaluation ambulatory arterial stiffness index and contrast-enhanced ultrasound in early hypertensive renal injury

目的:探讨动态动脉硬化指数(AASI)与超声造影(CEUS)在评估早期高血压肾损伤及动态改变中的临床价值及其相关性。方法:以尿微量白蛋白(UMA)为指标,将57例原发性高血压患者分为早期肾损伤组与正常组,严格降压治疗6个月后,观察治疗前、后AASI及右肾CEUS的变化及其相关性。结果:治疗前,肾损伤组AASI、曲线上升支斜率(A)及曲线下面积(AUC)高于正常组,而曲线达峰绝对值(DPI)低于正常组(P<0.05)。降压治疗6个月后,肾损伤组AASI较治疗前下降(P<0.05),而AUC、达峰时间(TTP)、DPI、A及曲线下降支斜率(α)与治疗前比较差异无统计学意义(P>0.05);正常组AASI、AUC、A较治疗前下降,而DPI高于治疗前(P<0.05)。所有患者治疗前、后AASI与AUC呈独立相关(P<0.05)。结论:AASI和CEUS可作为评估早期高血压肾损伤的灵敏与可靠指标,反应降压治疗对血管功能及肾灌注的影响。

Objective To investigate the dynamic changes of correlation and clinical value of ambulatory arterial stiffness index （AASI） and contrast-enhanced ultrasound （CEUS）in the assessment of early hypertensive renal injury. Methods Screening of 57 cases with primary hypertension, urinary albumin was selected as the index, and all patients were divided as early hypertensive renal injury group and no renal injury group. After 6 months of strict antihypertensive treatment, the changes and correlation of AASI and right renal CEUS were observed before and after treatment. Results Before treatment, the AASI, A and AUC of renal injury group were significantly higher than those in the no renal injury group （P 〈 0.05）, while DPI was significantly lower than those in the no renal injury group （P 〈 0.05）. After 6 months of antihypertensive treatment, the AASI of renal injury group was lower than before treatment （P 〈 0.05）, but AUC, TFP, DPI, A and ct had no differences compared with before treatment （P 〉 0.05）. After 6 months of antihypertensive treatment, the AASI, AUC and A of no renal injury group were decreased compared with before treatment, while DPI was higher than before treatment （P 〈 0.05）. All research patients before and after treatment, AASI and AUC were independently correlated （P 〈 0.05）. Conclusion The result showed that AASI and CEUS can be used as the sensitive and reliable parameter in evaluating early hypertensive renal injury, which can response the antihypertensive treatment effects on vascular function and renal perfusion.