慢性肾小球肾炎患者脉搏波传导速度和动脉顺应性的变化及影响因素研究

摘要

目的 探讨慢性肾小球肾炎患者脉搏波传导速度(PWV)、大动脉顺应性指数(C1)、小动脉顺应性指数(C2)的变化及其相关影响因素.方法 分析重庆医科大学附属第二医院肾内科住院的慢性肾小球肾炎患者90例,根据肾小球滤过率(eGFR),分为病变早中期组(39例)、晚期组(51例);另选取同期健康者72例为对照组.测定并比较受试者的PWV、C1、C2,并测定身高、体质量、24 h动态血压值、血肌酐、血尿酸、eGFR、尿蛋白定量、血脂.结果 与对照组相比,病变早中期组和晚期组PWV均增快,且晚期组快于早中期组,差异均有统计学意义(P＜0.05);病变早中期组和晚期组的C1、C2都较对照组降低,且晚期组低于早中期组,差异均有统计学意义(P＜0.05).PWV与eGFR呈负相关,与血尿酸、总胆固醇、血肌酐、各个动态血压值呈正相关;C1与eGFR呈正相关,与低密度脂蛋白、血尿酸、各个动态血压值呈负相关;C2与eGFR呈正相关,与血尿酸、血肌酐、各个动态血压值呈负相关.PWV的主要影响因素是eGFR、夜间舒张压(n-DBP),C1的主要影响因素是日间收缩压(d-SBP)、日间舒张压(d-DBP)、n-DPB,C2的主要影响因素是eGFR、夜间收缩压(n-SBP)、n-DBP、24 h舒张压(24 h-DBP).结论慢性肾小球肾炎患者随着病情进展,动脉硬化程度增高,多个致动脉硬化的危险因素并存.%Objective To investigate the changes of pulse wave velocity ( PWV ), large arterial compliance index ( C1 ), small arterial compliance index ( C2 ) and their related influencing factors in patients with chronic glomerulonephritis ( CGN ). Methods A total of 90 CGN patients hospitalized in this hospital were divided, according to glomerular filtration rate ( eGFR ), into groups A ( having early or medium lesions, n = 39 ), B ( having advanced lesions, n = 51 ). Seventy - two healthy subjects were enrolled as control group. Body height, weight, PWV, C1 , C2, 24 h ambulatory blood pressure values ( 24 h - ABP ), serum creatinine ( Cr ), uric acid ( RA ), eGFR, urinary protein ( UP ), blood lipids were determined. Results PWV was higher in groups A, B than in control group, higher in B group than in A group ( P < 0. 05 ). C1, C2 were lower in groups A, B than in control, lower in group B than in group A ( P <0. 05 ). PWV was negatively correlated with eGFR, positively with UA, total cholesterol, Cr, ABP. C1 was positively correlated with eGFR, negatively with low density lipo-protein, UA, ABP. C2 was positively correlated with eGFR, negatively with UA, Scr, ABP. The main influencing factors of PWV were eGFR, nighttime diastolic blood pressure ( n - DBP ); Those of Cl were daytime systolic blood pressure ( d - SBP ), daytime diastolic blood pressure ( d - DBP ), n - DBP; Those of C2 were eGFR, n - SBP, n - DBP, 24 h DBP. Conclusion With the progress of CGNm the degree of arteriosclerosis increases, coexisting with various atherogenic risk factors.