Heine Gunnar H, Reichart Birgit, Ulrich Christof, Köhler Hans, Girndt Matthias
Medical Department, Nephrology, University Homburg, D-66421 Homburg, Germany.
Nephrol Dial Transplant. 2007 Jan;22(1):163-70. doi: 10.1093/ndt/gfl484. Epub 2006 Aug 27.
In patients suffering from chronic kidney disease (CKD), ultrasound renal resistance indices predict progression of kidney disease and death. Although ultrasound resistance indices were initially considered to directly reflect intrarenal vascular resistance, they are complex composite parameters that are influenced by various vascular factors. We hypothesized that renal resistance indices reflect systemic vascular disease rather than local renal damage in patients with CKD.
In 140 patients suffering from CKD not receiving renal replacement therapy, intrarenal resistance indices were measured in interlobar arteries. For assessment of systemic atherosclerotic disease, common carotid intima-media thickness (IMT) and ankle-brachial blood pressure index were determined. Categories of risk for coronary heart diseases were defined by Framingham risk scoring.
Increased renal resistance indices were associated with high Framingham risk scores and with the presence of atherosclerotic disease. In addition, ultrasound renal resistance indices progressively increased with the stage of renal function impairment, and patients suffering from diabetic nephropathy had higher resistance indices than patients suffering from other renal diseases. In a multivariate linear regression analysis, IMT, Framingham risk score, renal function, presence of diabetic nephropathy and pulse pressure independently predicted resistance indices. However, when additionally adjusting for age, IMT and Framingham risk score were no longer independent predictors of resistance indices.
In patients suffering from CKD, intrarenal resistance indices are independently associated with cardiovascular risk score and systemic vascular disease as well as with aetiology and stage of CKD. This may explain their strong association with both impaired renal outcome and death.
在慢性肾脏病（CKD）患者中，超声肾阻力指数可预测肾病进展和死亡。尽管超声阻力指数最初被认为可直接反映肾内血管阻力，但它们是受多种血管因素影响的复杂复合参数。我们推测，CKD患者的肾阻力指数反映的是全身性血管疾病而非局部肾损伤。
对140例未接受肾脏替代治疗的CKD患者，测量其叶间动脉的肾内阻力指数。为评估全身性动脉粥样硬化疾病，测定了颈总动脉内膜中层厚度（IMT）和踝臂血压指数。采用弗雷明汉风险评分定义冠心病风险类别。
肾阻力指数升高与弗雷明汉高风险评分及动脉粥样硬化疾病的存在相关。此外，超声肾阻力指数随肾功能损害阶段逐渐升高，糖尿病肾病患者的阻力指数高于其他肾病患者。在多变量线性回归分析中，IMT、弗雷明汉风险评分、肾功能、糖尿病肾病的存在及脉压可独立预测阻力指数。然而，在进一步校正年龄后，IMT和弗雷明汉风险评分不再是阻力指数的独立预测因素。
在CKD患者中，肾内阻力指数与心血管风险评分、全身性血管疾病以及CKD的病因和阶段独立相关。这可能解释了它们与肾功能损害和死亡的强烈关联。
