Divisions of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Am J Hypertens. 2012 Dec;25(12):1292-8. doi: 10.1038/ajh.2012.113. Epub 2012 Aug 9.
The renal resistive index (RI) measured using Doppler ultrasonography has been used as a diagnostic tool in the daily work-up of kidney diseases. A better understanding of its relationship with preclinical organ damage may help in determining overall cardiovascular risk in hypertensive patients.
We evaluated the association between RI and the presence and degree of target organ damage (TOD) in 288 (130 male) essential hypertensive patients. RI, carotid intima-media thickness (IMT), and left ventricular (LV) mass index were assessed by ultrasound scan. Albuminuria was measured as the albumin-to-creatinine ratio (ACR) in three consecutive first morning urine samples.
In univariate analysis, patients with TOD showed significantly higher RI as compared with those without TOD (presence vs. absence of carotid wall thickening, LV hypertrophy, and albuminuria, P < 0.01, respectively). The severity of each TOD increased progressively from the lower to the upper RI tertile. Multiple logistic regression analysis found that each standard deviation increase in RI gave a 47% higher odds of having LV hypertrophy, and a 70% higher odds of having albuminuria (P < 0.05, respectively). The occurrence of at least two signs of TOD also significantly increased in parallel with elevation of RI (odds ratio (OR): 1.89 for 1 s.d. increase, P < 0.01).
These results suggest that increased RI may be a marker of subclinical TOD in patients with essential hypertension.
多普勒超声测量的肾血管阻力指数（RI）已被用作肾脏疾病日常检查的诊断工具。更好地了解其与临床前器官损伤的关系，可能有助于确定高血压患者的整体心血管风险。
我们评估了 288 名（130 名男性）原发性高血压患者的 RI 与靶器官损伤（TOD）的存在和严重程度之间的关系。RI、颈动脉内膜中层厚度（IMT）和左心室（LV）质量指数通过超声扫描进行评估。白蛋白尿通过连续三次晨尿样本的白蛋白与肌酐比值（ACR）进行测量。
在单因素分析中，与无 TOD 的患者相比，有 TOD 的患者的 RI 显著更高（颈动脉壁增厚、LV 肥厚和白蛋白尿的存在与不存在相比，P < 0.01）。每种 TOD 的严重程度从 RI 的较低三分位到较高三分位逐渐增加。多元逻辑回归分析发现，RI 每增加一个标准差，患 LV 肥厚的几率增加 47%，患白蛋白尿的几率增加 70%（P < 0.05）。随着 RI 的升高，至少有两种 TOD 征象的发生也显著增加（比值比（OR）：RI 增加 1 个标准差时为 1.89，P < 0.01）。
这些结果表明，RI 的增加可能是原发性高血压患者亚临床 TOD 的标志物。
