糖尿病合并高血压患者肾实质弹性的影响因素分析

Analysis of influencing factors on renal parenchymal elasticity in diabetic patients with hypertension

目的探讨影响糖尿病合并高血压患者肾实质弹性的因素。方法选取2016年8月至2017年3月在温州医科大学附属第二医院的住院患者167例,根据是否患糖尿病、高血压将167例患者分为3组,单纯糖尿病(DM)组、单纯高血压(HP)组及糖尿病合并高血压(DM+HP)组,同时选取50名健康志愿者为健康对照组。收集所有被检者基本临床资料,检测常规实验室指标,采用声触诊组织定量分析(VTQ)测量每个被检者左肾实质的剪切波速度(SWV),对上述各组间计量参数进行单因素方差分析,SWV值与各因素的联系采用多元逐步线性回归分析。结果 DM、HP及DM+HP组SWV值比较,DM+HP组高于DM组与HP组[(2.62±0.35)m/s vs(2.44±0.32)m/s,(2.62±0.35)m/s vs(2.49±0.27)m/s],差异均有统计学意义(t=-2.854,-2.198,P均<0.05),3组均高于健康对照组[(2.01±0.22)m/s],差异均有统计学意义(t=-7.854,-9.783,-10.787,P均<0.05)。多元线性回归分析显示,SWV与糖尿病病程、高血压病程、左肾实质厚度、左肾动脉主干血流阻力指数(RI)和尿酸有线性回归关系(标准化回归系数b′=0.488、0.159、-0.187、0.151、0.123,P均<0.05),其中与糖尿病病程、高血压病程、左肾动脉主干血流RI、尿酸呈正相关,与左肾实质厚度呈负相关。结论与肾实质弹性存在明显相关的主要因素有糖尿病病程、高血压病程、左肾实质厚度、左肾动脉主干血流RI和尿酸,对临床预防或延缓糖尿病合并高血压患者肾实质弹性改变有一定的指导作用。

Objective To investigate the factors affecting renal parenchymal elasticity in diabetic patients with hypertension. Methods According to the presence of diabetes and hypertension, 167 patients were divided into three groups: simple diabetes mellitus (DM) group, simple hypertension (HP) group and diabetes mellitus combined with hypertension (DM+ HP) group. Meanwhile, 50 healthy volunteers were selected as control group. The basic clinical data of subjects were collected, routine laboratory tests were detected, and virtual touch quantization (VTQ) was used to measure the left renal shear wave velocity (SWV). Then one-way ANOVA was used to analyze the measurement parameters among the above groups, and the relationship between SWV values and various factors was analyzed by multiple stepwise linear regression analysis. Results For SWV, there was significant difference among 4 groups. The SWV values in group DM+ HP were greater than that in group DM and group HP [(2.62±0.35) m/s vs (2.44±0.32) m/s,(2.62±0.35) m/s vs (2.49±0.27) m/s], the differences were statistically significant (t=-2.854,-2.198, all P<0.05). And all three patient groups had greater values of renal SWV than that of control group [(2.01±0.22) m/s], the differences were statistically significant (t=-7.854,-9.783,-10.787, all P<0.05). Multiple linear regression analysis showed that SWV had linear relationship with duration of diabetes, duration of hypertension, left renal parenchymal thickness, left renal artery blood flow resistance index (RI) and uric acid (standard regression coefficient b′=0.488, 0.159,-0.187, 0.151, 0.123, P<0.05, respectively). In details, SWV was positively correlated with duration of diabetes, duration of hypertension, left renal artery blood flow RI and uric acid, while negatively correlated with the left renal parenchymal thickness. Conclusions The main factors related to the elasticity of renal parenchyma were duration of diabetes, duration of hypertension, left renal parenchymal thickness, left renal artery blood flow RI and uric acid, which can be helpful for clinical prevention for renal parenchymal change in diabetic patients with hypertension.