From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.).
Hypertension. 2016 Mar;67(3):654-60. doi: 10.1161/HYPERTENSIONAHA.115.05924. Epub 2016 Jan 25.
The renal resistive index (RI) calculated by Doppler ultrasonography has been reported to be correlated with renal structural changes and outcomes in patients with essential hypertension or renal disease. However, little is known about this index in primary aldosteronism. In this prospective study, we examined the utility of this index to predict blood pressure (BP) outcome after adrenalectomy in patients with primary aldosteronism. We studied 94 patients with histopathologically proven aldosteronoma who underwent surgery. Parameters on renal function, including renal flow indices, were examined and followed up for 12 months postoperatively. The renal RI of the main, hilum, and interlobar arteries was significantly higher in patients with aldosteronoma compared with 100 control patients. BP, estimated glomerular filtration rate, and urinary albumin excretion significantly decreased after adrenalectomy. The resistive indices of all compartment arteries were significantly reduced 1 month after adrenalectomy and remained stable for 12 months. Patients whose interlobar RI was in the highest tertile at baseline had higher systolic BP after adrenalectomy than those whose RI was in the lowest tertile. Logistic regression analysis demonstrated that the RI of the interlobar and hilum arteries could be an independent predictive marker for intractable hypertension (systolic BP ≥140 mm Hg, increased BP, taking ≥3 antihypertensive agents, or increased number of agents) even after adrenalectomy. Therefore, in patients with aldosteronoma, the renal RI indicates partially reversible renal hemodynamics and renal structural damages that would influence postoperative BP outcome.
经多普勒超声计算的肾阻力指数（RI）已被报道与原发性高血压或肾脏疾病患者的肾结构变化和结局相关。然而，对于醛固酮增多症患者，该指数的了解甚少。在这项前瞻性研究中，我们研究了该指数在预测醛固酮增多症患者肾上腺切除术后血压（BP）结局方面的作用。我们研究了 94 例经组织病理学证实为醛固酮瘤的患者，这些患者接受了手术。检测了肾功能的参数，包括肾血流指数，并在术后 12 个月内进行了随访。与 100 例对照患者相比，醛固酮瘤患者的主、门、叶间动脉的 RI 明显更高。BP、估算肾小球滤过率和尿白蛋白排泄在肾上腺切除术后显著降低。所有节段动脉的阻力指数在肾上腺切除术后 1 个月显著降低，并在 12 个月内保持稳定。在基线时叶间 RI 处于最高三分位的患者，术后收缩压高于 RI 处于最低三分位的患者。Logistic 回归分析表明，叶间和门脉段动脉的 RI 可作为术后难治性高血压（收缩压≥140mmHg，BP 升高，服用≥3 种降压药，或药物种类增加）的独立预测标志物。因此，在醛固酮瘤患者中，肾 RI 表明部分可逆的肾血流动力学和肾结构损伤，这会影响术后 BP 结局。
