肾动脉阻力指数、TNF-α和IL-10在高血压肾损害患者中的变化及其相关性研究

摘要

Objective To investigate the changes of renal resistive index(RRI) and the serum levels of necrosis alpha(TNF-α) and interleukin 10(IL-10) in patients with hypertensive renal damage,whereby to explore the correlation of RRI,TNF-α and IL-10 with the hypertensive renal damage.Methods Seventy three patients with primary hypertension were divided into two groups according to their urinary albumin excretion rate:simple hypertension group(n =37),hypertensive renal damage group(n =36).RRI was measured using Doppler ultrasonography,serum TNF-α and IL-10 using radioimmune assay.Thirty normotensive healthy persons were selected as normotensive control group.Results RRI and TNF-α in the hypertension group were higher than those in the normotensive control group (P＜0.05),with RRI and TNF-α in the hypertensive renal damage group being higher than those in the simple hypertension group (P＜0.05) and IL-10 in the hypertension group was lower than that of normotensive control group (P＜0.05),IL-10 in the hypertensive renal damage group was also lower than that of simple hypertension group (P＜0.05).There was statistical significance in RRI,TNF-α and IL-10 between the groups (P＜0.05).RRI,TNF-α and IL-10 in the hypertension group were associated with the urinary albumin excretion rate(r=0.801,P＜0.01 ;r=0.703,P＜0.01 ;r=-0.613,P＜0.01).RRI was positively conelated with TNF-α(r=0.609,P＜0.001),negatively correlated with IL-10 (r=-0.533,P＜0.01),but not correlated with the level of blood pressure.Conclusion RRI is remarkably increased in patients with hypertensive renal damage,whereby can be used as a parameter in evaluating hypertensive renal damage.TNF-α is increased and IL-10 decreased significantly in patients with hypertensive renal damage,indicating that the imbalanced cytokine network may play a role in the pathological mechanisms of hypertensive renal damage.%目的 探讨肾动脉阻力指数(RRI)、肿瘤坏死因子α(TNF-α)和白细胞介素10(IL-10)在高血压肾损害患者中的变化及其相关性.方法 将73例高血压病患者根据其尿蛋白排泄率分为2组:单纯高血压组(n=37)和高血压肾损害组(n=36),应用超声多普勒检测RRI,并采用放射免疫法检测血清TNF-α、IL-10浓度.同期选择30例健康体检者作为正常血压对照组.结果 高血压病组RRI、TNF-α均高于正常血压对照组(P＜0.05),其中高血压肾损害组RRI、TNF-α高于单纯高血压组(P＜0.05).高血压病组IL-10低于正常血压对照组(P＜0.05),其中高血压肾损害组IL-10又低于单纯高血压组(P＜0.05).组间比较RRI、TNF-α和IL-10的差异有统计学意义(P＜0.05).高血压病组RRI、TNF-α、IL-10与尿蛋白排泄率相关(r=0.801,P＜0.01;r=0.703,P＜0.01;r=-0.613,P＜0.01).RRI和TNF-α呈正相关(r=0.609,P＜0.001),与IL-10呈负相关(r=-0.533,P＜0.01),而与血压水平无相关性.结论 高血压肾损害患者RRI升高,RRI可作为高血压肾损害的评价指标.高血压肾损害患者TNF-α升高,IL-10水平降低,细胞因子系统的失衡可能参与了高血压肾损害的进展.