本文選題：動態(tài)動脈硬化指數(shù) + 高血壓　； 參考：《西南醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討動態(tài)動脈硬化指數(shù)(Ambulatory Arterial Stiffness Index,AASI)與超聲造影(Contrast-enhanced Ultrasound,CEUS)在評估早期高血壓腎損傷及動態(tài)改變中的臨床價值及其相關性。方法:1、入選原發(fā)性高血壓患者57例為試驗對象。所有病例依據24小時尿微量白蛋白(UMA)為分組標準:早期高血壓腎損傷組(28例,平均年齡69.72±7.61,UMA為30-300mg/24h)與單純高血壓組(29例,69.72±7.61歲,UMA30mg/24h);2、所有病例根據試驗要求給予特定的降壓治療,隨訪6月,觀察治療前、后兩組間動態(tài)動脈硬化指數(shù)(AASI)及右腎超聲造影(CEUS)的變化,并分析CEUS與AASI是否存在相關性;3、AASI的計算方法:完成有效的24h小時動態(tài)血壓監(jiān)測后,采用回歸方程(舒張壓=a+b×收縮壓)計算得到各時段舒張壓與收縮壓之間的回歸關系。AASI的計算值為1與回歸斜率b的差值。4、CEUS檢查方法:囑患者取左側臥位,安靜受檢,避免呼吸不穩(wěn)、體位變動,選擇右腎最大長軸切面作為觀察區(qū)域,選定區(qū)域后固定超聲探頭,待選定圖像后,在注射SonoVue(聲諾維)的同時開始采集超聲影像,同步記錄腎臟超聲圖像改變5min,連續(xù)采集圖像動態(tài)變化,并收集腎灌注的每個時段的圖像和超聲變化。5.采用QLAB定量分析軟件,自動計算時間-強度曲線(Time—intensity curve,TIC曲線):將腎皮質感興趣區(qū)域內的圖像導入QLAB定量分析軟件,通過患者實時血流的微泡強度的變化,獲得TIC曲線。經過統(tǒng)計學處理,TIC曲線能自動獲取曲線下面積(area under curve,AUC)、曲線上升支斜率(slope rate of ascending curve,A)、曲線下降支斜率(slope rate of descending curve,α)、達峰時間(time to peak,TTP)、曲線達峰絕對值(derived peak intensity,DPI)等定量參數(shù)。結果:治療前高血壓腎損傷組曲線達峰絕對值DPI顯著低于單純高血壓組;AASI、AUC、A均顯著高于單純高血壓組(P0.05)。所有病例治療隨訪觀察6月后,再次行AASI和CEUS檢查,發(fā)現(xiàn)治療后腎損傷組AASI較治療前下降(P0.05);而AUC、A、TTP、DPI及α較治療前比較無統(tǒng)計學差異(P0.05)。經過嚴格控制血壓治療6月后,單純高血壓組AASI、AUC、A較治療前下降,而DPI高于治療前(P0.05)。所有研究對象治療前、后AASI與AUC呈獨立相關(P0.05);結論:1、AASI可以評估高血壓患者血管功能,并作為預測高血壓靶器官損傷的指標。2、腎臟CEUS可以實時反映腎血流灌注,并且通過TIC曲線下的參數(shù)的變化早期發(fā)現(xiàn)腎臟血管損傷和腎功能改變。3、AASI聯(lián)合腎臟CEUS可以作為發(fā)現(xiàn)和評估早期高血壓腎損傷,是較好的預測動脈僵硬度和潛在腎損傷風險的良好指標。
[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 鹵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, 偽, 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, 偽, 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 偽 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.
【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1;R692

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