Frauchiger B, Nussbaumer P, Hugentobler M, Staub D
Department of Internal Medicine, University Hospital, Basle, Switzerland.
Nephrol Dial Transplant. 2000 Jun;15(6):827-32. doi: 10.1093/ndt/15.6.827.
Nitroglycerine effects dilatation of the vas afferens in the kidney by its active metabolite nitric oxide (NO). In diabetic nephropathy, NO appears to cause hyperfiltration and proteinuria. The aim of this study was to investigate the potential of duplex Doppler ultrasonography in recording changes in resistive indices following nitroglycerine and whether the extent of changes in diabetic nephropathy is reduced as a result of the arteriolar dilatation mediated by NO.
Fifty-three subjects made up three groups: group 1, 12 young healthy volunteers (5 male, 7 female, 28+/-6 years); group 2, 21 older healthy volunteers (7 male, 14 female, 62+/-8 years); group 3, 20 patients (13 male, 7 female, 56+/-18 years) with mild diabetic nephropathy. The resistive index (RI) was measured in the interlobar arteries before, and 1, 3 and 5 min after administration of 0.8 mg sublingual nitroglycerine.
The initial RI of 0.592 decreased in group 1 by 10.8% (P<0. 01) after nitroglycerine, in group 2 the initial figure of 0.631 decreased by 5.9% (P<0.01), and in group 3 the initial figure of 0. 669 decreased by 3.4% (P<0.01). Initial RI values differed significantly between groups 1 and 3 (P<0.01) and groups 1 and 2 (P<0.01), as did values between all healthy volunteers (groups 1 and 2, n=33) and patients with nephropathy (P<0.005). The extent of DeltaRI differed significantly between groups 1 and 3 (P<0.01), 1 and 2 (P<0.02), and between all volunteers and group 3 (P<0.003). In groups 1 and 2 the initial RI was dependent on age (P<0.03), in group 3 on age and creatinine clearance (P<0.02 and P<0.05 respectively). DeltaRI correlated with age in the healthy subjects (P<0.01) and with duration of diabetes in diabetic nephropathy (P0. 03).
Haemodynamic changes in renal perfusion caused by nitroglycerine can be detected using duplex ultrasonography. In healthy subjects, DeltaRI declines with increasing age. In diabetic nephropathy patients, the response to nitroglycerine is reduced. The increased initial RI in such patients suggests fixed arteriolar damage.
硝酸甘油通过其活性代谢产物一氧化氮（NO）使肾内的入球小动脉扩张。在糖尿病肾病中，NO似乎会导致超滤过和蛋白尿。本研究的目的是探讨双功多普勒超声记录硝酸甘油给药后阻力指数变化的潜力，以及糖尿病肾病中变化程度是否因NO介导的小动脉扩张而降低。
53名受试者分为三组：第1组，12名年轻健康志愿者（5名男性，7名女性，28±6岁）；第2组，21名老年健康志愿者（7名男性，14名女性，62±8岁）；第3组，20例轻度糖尿病肾病患者（13名男性，7名女性，56±18岁）。在舌下含服0.8mg硝酸甘油前以及给药后1、3和5分钟测量叶间动脉的阻力指数（RI）。
第1组硝酸甘油给药后初始RI值0.592下降了10.8%（P<0.01），第2组初始值0.631下降了5.9%（P<0.01），第3组初始值0.669下降了3.4%（P<0.01）。第1组和第3组之间以及第1组和第2组之间的初始RI值差异有统计学意义（P<0.01），所有健康志愿者（第1组和第2组，n=33）与肾病患者之间的RI值差异也有统计学意义（P<0.005）。第1组和第3组之间、第1组和第2组之间以及所有志愿者与第3组之间的ΔRI程度差异有统计学意义（P<0.01、P<0.02和P<0.003）。在第1组和第2组中，初始RI与年龄有关（P<0.03），在第3组中与年龄和肌酐清除率有关（分别为P<0.02和P<0.05）。健康受试者中ΔRI与年龄相关（P<0.01），糖尿病肾病患者中ΔRI与糖尿病病程相关（P=0.03）。
使用双功超声可检测到硝酸甘油引起的肾灌注血流动力学变化。在健康受试者中，ΔRI随年龄增加而下降。糖尿病肾病患者对硝酸甘油的反应降低。此类患者初始RI升高提示存在固定的小动脉损伤。
