动态动脉硬化指数与超声造影对早期高血压肾损伤评估及动态观察的临床研究

发布时间：2018-05-20 13:24

本文选题：动态动脉硬化指数 + 高血压　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:探讨动态动脉硬化指数(Ambulatory Arterial Stiffness Index,AASI)与超声造影(Contrast-enhanced Ultrasound,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:1、入选原发性高血压患者57例为试验对象。所有病例依据24小时尿微量白蛋白(UMA)为分组标准:早期高血压肾损伤组(28例,平均年龄69.72±7.61,UMA为30-300mg/24h)与单纯高血压组(29例,69.72±7.61岁,UMA30mg/24h);2、所有病例根据试验要求给予特定的降压治疗,随访6月,观察治疗前、后两组间动态动脉硬化指数(AASI)及右肾超声造影(CEUS)的变化,并分析CEUS与AASI是否存在相关性;3、AASI的计算方法:完成有效的24h小时动态血压监测后,采用回归方程(舒张压=a+b×收缩压)计算得到各时段舒张压与收缩压之间的回归关系。AASI的计算值为1与回归斜率b的差值。4、CEUS检查方法:嘱患者取左侧卧位,安静受检,避免呼吸不稳、体位变动,选择右肾最大长轴切面作为观察区域,选定区域后固定超声探头,待选定图像后,在注射SonoVue(声诺维)的同时开始采集超声影像,同步记录肾脏超声图像改变5min,连续采集图像动态变化,并收集肾灌注的每个时段的图像和超声变化。5.采用QLAB定量分析软件,自动计算时间-强度曲线(Time—intensity curve,TIC曲线):将肾皮质感兴趣区域内的图像导入QLAB定量分析软件,通过患者实时血流的微泡强度的变化,获得TIC曲线。经过统计学处理,TIC曲线能自动获取曲线下面积(area under curve,AUC)、曲线上升支斜率(slope rate of ascending curve,A)、曲线下降支斜率(slope rate of descending curve,α)、达峰时间(time to peak,TTP)、曲线达峰绝对值(derived peak intensity,DPI)等定量参数。结果:治疗前高血压肾损伤组曲线达峰绝对值DPI显著低于单纯高血压组;AASI、AUC、A均显著高于单纯高血压组(P0.05)。所有病例治疗随访观察6月后,再次行AASI和CEUS检查,发现治疗后肾损伤组AASI较治疗前下降(P0.05);而AUC、A、TTP、DPI及α较治疗前比较无统计学差异(P0.05)。经过严格控制血压治疗6月后,单纯高血压组AASI、AUC、A较治疗前下降,而DPI高于治疗前(P0.05)。所有研究对象治疗前、后AASI与AUC呈独立相关(P0.05);结论:1、AASI可以评估高血压患者血管功能,并作为预测高血压靶器官损伤的指标。2、肾脏CEUS可以实时反映肾血流灌注,并且通过TIC曲线下的参数的变化早期发现肾脏血管损伤和肾功能改变。3、AASI联合肾脏CEUS可以作为发现和评估早期高血压肾损伤,是较好的预测动脉僵硬度和潜在肾损伤风险的良好指标。
[Abstract]:Objective: to evaluate the clinical value of dynamic arteriosclerosis Arterial Stiffness index (AASI) and contrast-enhanced ultrasonography (Contrast-enhanced ultrasound CEU) in the evaluation of renal injury and dynamic changes in patients with hypertension. Methods 57 patients with essential hypertension were selected as subjects. All patients were divided into two groups: early hypertensive renal injury group (n = 28, mean age: 69.72 卤7.61 UMA = 30-300 mg / 24 h) and simple hypertension group (n = 29, UMA 30 mg / 24 h, n = 29). All patients were given specific hypotension therapy according to the test requirements. After 6 months follow-up, the changes of dynamic arteriosclerosis index (AASI) and right renal contrast echocardiography (CEUs) were observed before and after treatment, and the correlation between CEUS and AASI was analyzed. Regression equation was used to calculate the regression relationship between diastolic blood pressure and systolic blood pressure. The calculated value of AASI was 1 and the difference value of regression slope b. 4 CEUs. To avoid breathing instability and body position change, select the maximum long axis of the right kidney as the observation area, fix the ultrasonic probe behind the selected area, and after the selected image, begin to collect the ultrasound image at the same time of injecting Sono Vue( sonoVue). The changes of renal ultrasound images were recorded simultaneously for 5 minutes, and the dynamic changes of renal images were continuously collected, and the images and ultrasound changes of each period of renal perfusion were collected. QLAB quantitative analysis software was used to calculate the time-intensity curve and time-intensity curve automatically. The images of the area of interest in the renal cortex were imported into the QLAB quantitative analysis software. The TIC curve was obtained by the change of the microbubble intensity of the real-time blood flow of the patients. After statistical analysis, quantitative parameters such as area under curve, slope of slope rate of ascending rate of descending curve, 伪, peak time to peak-tpd, absolute value of derived peak intensity-DPIs can be obtained automatically under the curve, and the slope of slope rate of ascending curve can be obtained by means of statistical analysis, and the quantitative parameters can be obtained by means of statistical analysis, such as the slope of ascending branch of curve is slope rate of descending curve, 伪, the time of reaching peak is time to peak-tpp, and the absolute value of curve peak is derived peak intensity-DPI. and so on. Results: the absolute value of DPI in hypertensive renal injury group was significantly lower than that in simple hypertension group (P 0.05). All the patients were followed up for 6 months, then AASI and CEUS were performed again. It was found that the AASI in the renal injury group was lower than that before treatment (P 0.05), but there was no significant difference in AASI and 伪 between the two groups before and after treatment (P 0.05). After 6 months of strictly controlled blood pressure therapy, AASI AUC A was lower in simple hypertension group than that before treatment, while DPI was higher than that before treatment (P 0.05). Before and after treatment, there was an independent correlation between AASI and AUC in all subjects before treatment, conclusion the blood vessel function of patients with hypertension can be evaluated by 1% AASI, and renal CEUS can reflect renal blood flow perfusion in real time as a predictor of target organ injury in patients with hypertension. In addition, early detection of renal vascular injury and renal function changes combined with renal CEUS can be used to detect and evaluate early hypertensive renal injury through the change of parameters under TIC curve. It is a good predictor of arterial stiffness and potential renal injury risk.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R692

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