Heine Gunnar H, Gerhart Markus K, Ulrich Christof, Köhler Hans, Girndt Matthias
Medical Department IV, Nephrology, University Homburg, Homburg, Germany.
Kidney Int. 2005 Aug;68(2):878-85. doi: 10.1111/j.1523-1755.2005.00470.x.
In kidney transplant recipients, increased intrarenal resistance indices measured by duplex ultrasound are associated with poor subsequent allograft performance. It remains unclear whether high resistance indices rather reflect local renal damage or systemic vessel disease. We hypothesized that resistance indices are associated with cardiovascular risk factors and with subclinical systemic atherosclerosis in transplant recipients.
In 105 renal transplant recipients, categories of risk for coronary heart disease were determined by Framingham risk scoring. Intrarenal resistive index (RI) and pulsatility index (PI) were measured in segmental arteries at five representative locations. For assessment of subclinical atherosclerosis, common carotid intima-media thickness, and ankle-brachial blood pressure index (ABI) were determined.
Transplant recipients with high coronary risk had higher intrarenal resistance indices than low-risk patients. Higher age, female gender, and lower body mass index were independently associated with increased resistance indices. Renal resistance indices were correlated with common carotid intima-media thickness [RI: r= 0.270 (P= 0.005); PI: r= 0.355 (P < 0.001)]. This association remained significant after adjusting for renal function. Renal resistance indices were increased in patients with pathologic ankle-brachial-indices compared to patients with physiologic ankle-brachial-indices [RI: 73.3 +/- 7.1 vs. 70.2 +/- 6.9 (P= 0.03); PI: 146.4 +/- 29.9 vs. 131.4 +/- 25.9 (P= 0.01)]. Renal resistance indices were neither significantly correlated with glomerular filtration rate (GFR), nor with donor age.
Intrarenal resistance indices are a complex integration of arterial compliance, pulsatility, and peripheral resistance. They are associated with traditional cardiovascular risk factors as well as with subclinical atherosclerotic vessel damage and should thus not be considered specific markers of renal damage.
在肾移植受者中，经双功超声测量的肾内阻力指数升高与随后移植肾的不良表现相关。目前尚不清楚高阻力指数究竟反映的是局部肾损害还是全身血管疾病。我们推测阻力指数与移植受者的心血管危险因素及亚临床全身动脉粥样硬化有关。
对105例肾移植受者，采用弗雷明汉风险评分确定冠心病风险类别。在五个代表性部位的节段动脉中测量肾内阻力指数（RI）和搏动指数（PI）。为评估亚临床动脉粥样硬化，测定了颈总动脉内膜中层厚度和踝臂血压指数（ABI）。
高冠心病风险的移植受者肾内阻力指数高于低风险患者。年龄较大、女性及较低的体重指数与阻力指数升高独立相关。肾阻力指数与颈总动脉内膜中层厚度相关[RI：r = 0.270（P = 0.005）；PI：r = 0.355（P < 0.001）]。在调整肾功能后，这种关联仍然显著。与生理踝臂指数的患者相比，病理踝臂指数的患者肾阻力指数升高[RI：73.3±7.1 vs. 70.2±6.9（P = 0.03）；PI：146.4±29.9 vs. 131.4±25.9（P = 0.01）]。肾阻力指数与肾小球滤过率（GFR）及供体年龄均无显著相关性。
肾内阻力指数是动脉顺应性、搏动性和外周阻力的复杂综合指标。它们与传统心血管危险因素以及亚临床动脉粥样硬化血管损伤相关，因此不应被视为肾损害的特异性标志物。
