Mazza Alberto, Rampin Lucia, Montemurro Domenico, Schiavon Laura, Zuin Marco, Grassetto Gaia, Chondrogiannis Sotirios, Al-Nahhas Adil, Ramazzina Emilio, Rubello Domenico
Department of Internal Medicine, 'Santa Maria della Misericordia' Hospital of Rovigo, Italy.
Blood Press. 2011 Dec;20(6):387-93. doi: 10.3109/08037051.2011.622860. Epub 2011 Oct 24.
BACKGROUND. This cross-sectional study investigates the role of renal scintigraphy on cardiovascular (CV) risk stratification in normoalbuminuric, non-diabetic hypertensive subjects (HTs) free from CV disease and renal dysfunction. METHODS. In 200 HTs aged 55-75 years, glomerular filtration rate (GFR) was measured by technetium-99m-diethylene triamine pentacetic acid clearance during renal scintigraphy. Stage III chronic kidney disease (CKD) was defined as GFR < 60 ml/min/1.73 m(2). For comparing the impact of different methods for CKD diagnosis on CV risk stratification, CKD was also considered as GFR estimated by the Modification of Diet in Renal Disease (MDRD) equation and Cockcroft-Gault's formula. Target organ damage (TOD) was assessed by echocardiography and carotid ultrasonography. Gender-specific odds ratio (OR) with 95% confidence intervals for CKD were derived from a multiple stepwise logistic regression analysis. Global CV risk was stratified according to routine examinations, TOD and CKD. RESULTS. In 38% of cases, an unknown stage III CKD was found. Independent of age, CKD was predicted by history of hypertension (OR = 1.69, p = 0.0001), albuminuria (OR = 1.25, p = 0.0001), smoking (OR = 1.85, p = 0.028) and pulse pressure (OR = 1.21, p = 0.019) in men only. Men had an increased risk of CKD (OR = 2.62, p = 0.002) in comparison with women. Prevalence of TOD was significantly higher only in HTs having CKD diagnosed by renal scintigraphy; TOD and CKD assessment added to classic risk factors modified the CV risk stratification from low-moderate to high and very high. CONCLUSIONS. Renal scintigraphy is an important aid in risk stratification and should be performed in HTs aged >55 years. Pulse pressure was the main blood pressure component that predicted the risk of stage III CKD.
背景。这项横断面研究调查了肾闪烁显像在无心血管疾病和肾功能不全的正常白蛋白尿、非糖尿病高血压患者（HT）的心血管（CV）风险分层中的作用。方法。在200名年龄在55 - 75岁的HT患者中，通过肾闪烁显像期间的锝-99m - 二乙三胺五乙酸清除率测量肾小球滤过率（GFR）。III期慢性肾脏病（CKD）定义为GFR < 60 ml/min/1.73 m²。为了比较不同的CKD诊断方法对CV风险分层的影响，CKD也被视为通过肾脏病饮食改良（MDRD）方程和Cockcroft - Gault公式估算的GFR。通过超声心动图和颈动脉超声评估靶器官损害（TOD）。来自多步逻辑回归分析得出CKD的性别特异性优势比（OR）及95%置信区间。根据常规检查、TOD和CKD对总体CV风险进行分层。结果。在38%的病例中发现了未知的III期CKD。独立于年龄，仅在男性中，高血压病史（OR = 1.69，p = 0.……此处原文有误，应为0.0001）、蛋白尿（OR = 1.25，p = 0.0001）、吸烟（OR = 1.85，p = 0.028）和脉压（OR = 1.21，p = 0.019）可预测CKD。与女性相比，男性患CKD的风险增加（OR = 2.62，p = 0.002）。仅在通过肾闪烁显像诊断为CKD的HT患者中，TOD的患病率显著更高；将TOD和CKD评估添加到经典危险因素中可将CV风险分层从低 - 中度改变为高和非常高。结论。肾闪烁显像在风险分层中是一项重要辅助检查，应在年龄>55岁的HT患者中进行。脉压是预测III期CKD风险的主要血压成分。
