高血压患者早期肾损害肾内血流动力学异常的临床研究

目的探讨原发性高血压合并早期肾损害患者肾内动脉血流动力学改变。方法根据血α1-微球蛋白及血、尿β2-微球蛋白水平将90例轻、中度原发性高血压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）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）。结论在高血压早期肾损害阶段,存在肾内血流动力学异常。

The changes of the hemodynamics of intrarenal arterial in essential hypertensive patients with early renal damaged

Objective To study the changes of hemodynamics of intrarenal arterial in the essential hypertensive patients.Methods 90 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-microglobulin and urine β2-microglobulin scale（bα1-MG20mg/L and/or bβ2-MG3550μg/L and/or uβ2-MG154μg/L,n=45;bα1-MG≤20mg/L and/or bβ2-MG≤3550μg/L and/or uβ2-MG≤154μg/L n=45）,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.Results Compared with the control group,Vs,Vd and Vm of both sides of MRA in the EH patients were significantly lower（P0.05）,AT were not significantly prolonged（P0.05） and PI,RI were highter（P0.05）;Vs,Vd and Vm of both sides of SRA and IRA in the EH patients were significantly lower（P0.05）,AT were significantly prolonged（P0.05）,PI,RI were highter（P0.05） 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（P0.05）,AT were significantly prolonged（P0.05）and PI,RI were highter（P0.05）.Conclusion When the EH patients with early renal damaged,the hemodynamics of intrarenal arterial had obvious changed.