Department of Internal Medicine IV, University of Saarland, Homburg, Germany.
Nephrol Dial Transplant. 2010 Apr;25(4):1294-300. doi: 10.1093/ndt/gfp631. Epub 2009 Nov 26.
In renal allograft recipients, ultrasound resistance indices (RI) have been discussed as predictors of transplant survival. RI measurements are correlated with subclinical atherosclerosis. It is thus unclear whether RI measurements represent specific markers of allograft damage or merely reflect systemic vascular damage. We studied whether RI are superior outcome predictors compared to markers of subclinical atherosclerosis and global cardiovascular risk.
In 105 renal transplant patients, intrarenal RI and common carotid intima-media thickness (IMT) were measured. Risk for coronary heart disease was determined by Framingham risk scoring (FRS). Patients were followed up for 5.4 +/- 0.4 years. The combined end point was a decrease of > or =50% in estimated glomerular filtration rate, need for dialysis or death.
Both an increased IMT and a high FRS were predictors of the combined end point. In contrast, increased RI did not significantly predict the combined end point in the entire cohort. Only among low-risk patients with either normal IMT or FRS < or =20%, high RI measurements were associated with allograft loss.
Compared to markers of cardiovascular risk or systemic atherosclerosis, renal RI are inferior outcome predictors in unselected transplant recipients. Only in patients with mild or moderate cardiovascular risk may RI measurements allow additional risk stratification.
在肾移植受者中，超声阻力指数（RI）被认为是移植存活的预测因子。RI 测量与亚临床动脉粥样硬化相关。因此，尚不清楚 RI 测量是代表同种异体移植物损伤的特异性标志物，还是仅仅反映全身血管损伤。我们研究了 RI 是否优于亚临床动脉粥样硬化和整体心血管风险的标志物作为预后预测因子。
在 105 例肾移植患者中，测量了肾内 RI 和颈总动脉内膜-中层厚度（IMT）。通过 Framingham 风险评分（FRS）确定冠心病风险。患者随访 5.4 +/- 0.4 年。复合终点为估计肾小球滤过率下降>或=50%、需要透析或死亡。
IMT 增加和 FRS 高均是复合终点的预测因子。相比之下，RI 增加在整个队列中并未显著预测复合终点。仅在 IMT 正常或 FRS <或=20%的低危患者中，高 RI 测量值与移植物丢失相关。
与心血管风险或系统性动脉粥样硬化标志物相比，RI 是未选择的移植受者预后预测因子较差。只有在心血管风险较低或中度的患者中，RI 测量值可能允许进行额外的风险分层。
