摘要
目的:探讨原发性高血压并发早期肾损害患者肾内动脉血流动力学改变与血浆内皮素(ET-1)和降钙素基因相关肽(CGRP)水平变化的相关性。方法:根据血α1-微球蛋白及血、尿β2-微球蛋白水平将90例原发性高血压患者分为早期肾损害组(45例)和无早期肾损害组(45例),另选择健康志愿者43例为对照组。采用ELISA法对各组血浆ET-1、CGRP水平进行测定,同时用彩色超声多谱勒技术测量双侧主肾动脉(MRA)、叶段动脉(SRA)、叶间动脉(IRA)的血流收缩期峰速度(Vs)、舒张期末血流速度(Vd)、平均血流速度(Vm)、血流峰速加速时间(AT)、脉冲指数(PI)、阻力指数(RI),以上各血流参数均取左右肾动脉平均值。结果:高血压组与对照组比较,MRA、SRA、IRA的Vs、Vd、Vm显著降低(P<0.05),PI、RI明显增高(P<0.05)、AT无明显延长(P>0.05);且Vs、Vd、Vm随血压分级的增加而降低,AT随血压分级的增加而延长,PI、RI随血压分级的增加而升高。高血压早期肾损害组与无早期肾损害组比较,SRA、IRA的Vs、Vd、Vm显著降低(P<0.05),AT明显延长(P<0.05),PI和RI明显增高(P<0.05)。高血压组与对照组比较,血浆ET-1水平明显增高(P<0.01),CGRP显著降低(P<0.01)。高血压早期肾损害组与无早期肾损害组比较,血浆ET-1水平明显增高(P<0.001),CGRP显著降低(P<0.01)。直线相关分析显示,ET-1与MRA、SRA、IRA的Vs、Vd、Vm负相关(P<0.01),与PI、RI、AT正相关(P<0.01);CGRP与MRA、SRA、IRA的PI、RI、AT负相关(P<0.01),与Vs、Vd、Vm正相关(P<0.01),均以IRA的Vd、RI相关性最好。结论:在高血压早期肾损害阶段,存在肾内血流动力学异常;而ET-1水平升高和CGRP水平下降可能是高血压早期肾损害肾内血流力学异常的原因之一。
Objective：To study the relationship between the changes of hemodynamics of intrarenal arterial and the levels of ET-1, CGRP in plasma of the essential hypertensive patients （EH） Methood： Ninety patients with mild to moderate EH were divided into EH patients with early renal damaged and EH patients without early renal damaged groups according to the level of blood α1-microglobulin,β2- mieroglobulin and urine,β2- microglobulin scale （b α1-MG〉20 mg/L and/or b β2-MG〉3 550 μg/L and/or u β2-MG〉154μg/L,n=45; b α1-MG≤20 mg/L and/or b β2-MG≤3 550μg/L and/or u βz-MG≤154 μg/L n=45） ; were divided into two groups according to their clinical blood presure （CBP） scale （systolic blood pressure [SBP] 140-159 mmHg and/or diastolic blood presure [DBP] 90-99 mmHg n=46; SBP 160-179 mmHg and/or DBP 100-109 mmHg n=44）, with 43 health as control group. Vs,Vd, Vm, AT, PI and RI of both sides of MRA, SRA and IRA were measured by Color Doppler echocardiography and all parameter of hemodynamics were decided by means of both sides intrarenal arterial while the levels of ET-1,CGRP and in plasma were measured by enzyme linked immunoscorbent assay（ELISA）. Result： Compared with the control group, Vs, Vd and Vm of both sides of MRA in the EH patients were significantly lower（P〈0. 05）, AT were not significantly prolonged （P〈0. 05） and PI, RI were highter（P〈0. 05）; Vs, Vd and Vm of both sides of SRA and IRA in the EH patients were significantly lower （P〈0.05）, AT were significantly prolonged（P〈0.05）, PI, RI were highter （P〈0.05） and Vs, Vd, Vm were lower, AT were prolonged and PI, RI were highter with the grade of clinical blood pressure （CBP） were up. Compared with the EH patients without early renal damaged group,Vs,Vm and Vd of both sides of SRA and IRA in the EH patients with early renal damaged group we significantly lower （P〈0.05）, AT were significantly prolonged（P〈0.05） and PI, RI were highter （P〈0.05）. Compared with the control grou
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2009年第5期348-352,共5页
Journal of Clinical Cardiology
关键词
高血压
肾血流动力学
内皮素
降钙素基因相关肽
彩色多普勒
hypertention
hemodynamics
intrarenal arterial
endothelin-1
Calcitonin Gene-related Peptide
Color Doppler echocardiography
