妊娠高血压综合征患者肾脏三维超声参数与血管内皮功能的相关分析
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摘要
目的应用三维彩色血管能量显像(3D-CPA)联合VOCAL技术定量分析妊娠高血压综合征(以下简称妊高征)患者肾脏血流灌注情况,探讨该技术参数与血管内皮功能的相关性,以期为临床评估病情提供新的途径。方法随机选取妊高征患者80例,其中妊娠期高血压组(GH)36例,子痫前期组(PE)44例;48例正常孕妇作为对照组。3D-CPA联合VOCAL技术获取肾脏血管化指数(VI)、血流指数(FI)及血管化血流指数(VFI)。检测孕妇血清内皮素(ET-1)及一氧化氮(NO)水平。结果 VI、FI及VFI在对照组、GH组和PE组中均呈下降趋势(P<0.01),ET-1及NO水平在对照组、GH组和PE组中分别呈上升、下降趋势(P<0.01)。VI、FI及VFI与血清ET-1均呈负相关,与NO均呈正相关(P<0.01)。结论妊高征患者肾脏血流灌注参数VI、FI及VFI与反应血管内皮功能的敏感指标ET-1、NO有良好的相关性,可用于反映肾脏损害及病情严重程度。
Objective To evaluate renal vascular perfusion quantitatively in patients with pregnancy-induced hypertension by three-dimensional color power angiography(3 D-CPA) and VOCAL technique, and explore the correlation between parameters and vascular endothelial function, with the view of providing a new route for clinical evaluation. Methods 80 cases of pregnancy-induced hypertension were chosen randomly, including 36 cases of gestational hypertension(GH) and 44 cases of pre-eclampsia(PE). 48 cases of normal pregnancy were enrolled as control group. 3 D-CPA and VOCAL technique were used to calculate the parameters of vascularization index(VI), flow index(FI), vascularization-flow index(VFI). The levels of serum endothelin-1(ET-1) and nitric oxide(NO) were measured. Results The parameters VI, FI and VFI showed a decreased tendency in control group, GH group and PE group(P<0.01). The levels of ET-1 and NO showed increased and decreased tendency in control group, GH group and PE group respectively(P<0.01). The parameters VI, FI and VFI exhibited inverse correlation with ET-1, and positive correlation with NO(P<0.01). Conclusion The parameters of renal vascular perfusion VI, FI and VFI had good correlation with ET-1, NO. The parameters can reflect the severity of renal injury and the disease in patients with pregnancy-induced hypertension.
Objective To evaluate renal vascular perfusion quantitatively in patients with pregnancy-induced hypertension by three-dimensional color power angiography(3 D-CPA) and VOCAL technique, and explore the correlation between parameters and vascular endothelial function, with the view of providing a new route for clinical evaluation. Methods 80 cases of pregnancy-induced hypertension were chosen randomly, including 36 cases of gestational hypertension(GH) and 44 cases of pre-eclampsia(PE). 48 cases of normal pregnancy were enrolled as control group. 3 D-CPA and VOCAL technique were used to calculate the parameters of vascularization index(VI), flow index(FI), vascularization-flow index(VFI). The levels of serum endothelin-1(ET-1) and nitric oxide(NO) were measured. Results The parameters VI, FI and VFI showed a decreased tendency in control group, GH group and PE group(P<0.01). The levels of ET-1 and NO showed increased and decreased tendency in control group, GH group and PE group respectively(P<0.01). The parameters VI, FI and VFI exhibited inverse correlation with ET-1, and positive correlation with NO(P<0.01). Conclusion The parameters of renal vascular perfusion VI, FI and VFI had good correlation with ET-1, NO. The parameters can reflect the severity of renal injury and the disease in patients with pregnancy-induced hypertension.
引文
1 American College of Obstetricians and Gynecologists.Hypertension in pregnancy.Report of the American College of Obstetricians and Gynecologists′ Task Force on hypertension in pregnancy[J].Obstetr Gynecol,2013,122(5):1122-1131
2 Mohaupt M.Molecular aspects of preeclampsia[J].Mole Aspect Med,2007,28(2):169-191
3 Naljayan MV,Karumanchi SA.New developments in the pathogenesis of preeclampsia[J].Adv Chronic Kidney Dis,2013,20(3):265-270
4 Hussein W,Lafayette RA.Renal function in normal and disordered pregnancy[J].Curr Opin Nephrol Hypertension,2014,23(1):46-53
5 乐杰,妇产科学 [M].7版.北京:人民卫生出版社,2008:92-100
6 Bahser N,Godehardt E,Hess AP,et al.Examination of intrarenal resistance indices indicate the involvement of renal pathology as a significant diagnostic classifier of preeclampsia[J].Am J Hypertension 2014,27(5):742-749
7 Liu X,Zhou Z,Cao Y,et al.Contributions of blood pressure to proteinuria and renal function in the puerperium[J].Blood Pressure 2009,18(6):362-366
8 Cazzaniga M,Salerno F,Visentin S,et al.Increased flow-mediated vasodilation in cirrhotic patients with ascites:relationship with renal resistive index[J].Liver Int,2008,28(10):1396-1401
9 杨孜,张为远.妊娠期高血压疾病诊治指南(2015)[J].中华产科急救电子杂志,2015,50(4):206-213
10 李华,雒雪,王宝兰,等.妊娠期高血压疾病患者尿脂联素,内皮素-1 和一氧化氮水平变化及意义[J].中国妇幼保健,2012,27(30):4698-4700
11 Celik H,Avci B,Iik Y.Vascular endothelial growth factor and endothelin-1 levels in normal pregnant women and pregnant women with pre-eclampsia[J].J Obstetr Gynaecol,2013,33(4):355-358
12 Palma-Reis I,Vais A,Nelson-Piercy C,et al.Renal disease and hypertension in pregnancy[J].Clin Med,2013,13(1):57-62
13 Abdel Razik M,El-Berry S,Abosereah M,et al.Prophylactic treatment for preeclampsia in high-risk teenage primigravidae with nitric oxide donors:a pilot study[J].J Maternal-Fetal Neonat Med,2016,29(16):2617-2620
14 左杰,张立军,史启铎.妊娠高血压患者肾血流动力学与血管内皮功能的相关性研究[J].中华超声影像学杂志,2013,22(5):406-409
15 Mirza FG,Cleary KL.Pre-eclampsia and the kidney[J].Semin Perinatol,2009,33(3):173-178
16 薛莉,刘泽军,欧阳迎春,等.高血压早期肾损害肾内血流动力学异常与内皮素及降钙素基因相关肽的研究[J].临床心血管杂志 2009,25(5):348-352
17 Freeman RK.Antepartum testing in patients with hypertensive disorders in pregnancy[J].Semin Perinatol,2008,32(4):271-273
18 Cansu A,Kupeli A,Kul S,et al.Evaluation of the relationship between renal function and renal volume-vascular indices using 3D power Doppler ultrasound[J].Eur J Radiol,2014,83(7):1080-1085
19 Kim HC,Yang DM,Jin W,et al.Relation between total renal volume and renal function:usefulness of 3D sonographic measurements with a matrix array transducer[J].Am J Roentgenol,2010,194(2):W186-W192
20 吴迪,王学梅,刘艳君,等.三维超声血管指数及肾脏体积在慢性肾脏疾病诊断中的价值[J].中国医学影像技术,2010,4:756-759
21 胡巧洪,范小明.三维彩色血管能量成像对高血压病肾脏血流灌注的研究[J].全科医学临床与教育,2009,7(3):213-215
2 Mohaupt M.Molecular aspects of preeclampsia[J].Mole Aspect Med,2007,28(2):169-191
3 Naljayan MV,Karumanchi SA.New developments in the pathogenesis of preeclampsia[J].Adv Chronic Kidney Dis,2013,20(3):265-270
4 Hussein W,Lafayette RA.Renal function in normal and disordered pregnancy[J].Curr Opin Nephrol Hypertension,2014,23(1):46-53
5 乐杰,妇产科学 [M].7版.北京:人民卫生出版社,2008:92-100
6 Bahser N,Godehardt E,Hess AP,et al.Examination of intrarenal resistance indices indicate the involvement of renal pathology as a significant diagnostic classifier of preeclampsia[J].Am J Hypertension 2014,27(5):742-749
7 Liu X,Zhou Z,Cao Y,et al.Contributions of blood pressure to proteinuria and renal function in the puerperium[J].Blood Pressure 2009,18(6):362-366
8 Cazzaniga M,Salerno F,Visentin S,et al.Increased flow-mediated vasodilation in cirrhotic patients with ascites:relationship with renal resistive index[J].Liver Int,2008,28(10):1396-1401
9 杨孜,张为远.妊娠期高血压疾病诊治指南(2015)[J].中华产科急救电子杂志,2015,50(4):206-213
10 李华,雒雪,王宝兰,等.妊娠期高血压疾病患者尿脂联素,内皮素-1 和一氧化氮水平变化及意义[J].中国妇幼保健,2012,27(30):4698-4700
11 Celik H,Avci B,Iik Y.Vascular endothelial growth factor and endothelin-1 levels in normal pregnant women and pregnant women with pre-eclampsia[J].J Obstetr Gynaecol,2013,33(4):355-358
12 Palma-Reis I,Vais A,Nelson-Piercy C,et al.Renal disease and hypertension in pregnancy[J].Clin Med,2013,13(1):57-62
13 Abdel Razik M,El-Berry S,Abosereah M,et al.Prophylactic treatment for preeclampsia in high-risk teenage primigravidae with nitric oxide donors:a pilot study[J].J Maternal-Fetal Neonat Med,2016,29(16):2617-2620
14 左杰,张立军,史启铎.妊娠高血压患者肾血流动力学与血管内皮功能的相关性研究[J].中华超声影像学杂志,2013,22(5):406-409
15 Mirza FG,Cleary KL.Pre-eclampsia and the kidney[J].Semin Perinatol,2009,33(3):173-178
16 薛莉,刘泽军,欧阳迎春,等.高血压早期肾损害肾内血流动力学异常与内皮素及降钙素基因相关肽的研究[J].临床心血管杂志 2009,25(5):348-352
17 Freeman RK.Antepartum testing in patients with hypertensive disorders in pregnancy[J].Semin Perinatol,2008,32(4):271-273
18 Cansu A,Kupeli A,Kul S,et al.Evaluation of the relationship between renal function and renal volume-vascular indices using 3D power Doppler ultrasound[J].Eur J Radiol,2014,83(7):1080-1085
19 Kim HC,Yang DM,Jin W,et al.Relation between total renal volume and renal function:usefulness of 3D sonographic measurements with a matrix array transducer[J].Am J Roentgenol,2010,194(2):W186-W192
20 吴迪,王学梅,刘艳君,等.三维超声血管指数及肾脏体积在慢性肾脏疾病诊断中的价值[J].中国医学影像技术,2010,4:756-759
21 胡巧洪,范小明.三维彩色血管能量成像对高血压病肾脏血流灌注的研究[J].全科医学临床与教育,2009,7(3):213-215