Hannedouche T, Chauveau P, Ferhat A, Loubaris T, Jungers P
Département de néphrologie, hôpital Necker, Paris, France.
Arch Mal Coeur Vaiss. 1988 Jun;81 Spec No:203-6.
Influence of systemic arterial pressure on the progression rate of renal function in patients with advanced CRF is still controversial. In a retrospective analysis of 167 patients with well-characterized primitive nephropathy, we analyzed the influence of mean arterial pressure (MAP), either treated or untreated, on the progression rate of CRF as judged by the time interval elapsed between plasma creatinine 500 mumol/l and first iterative hemodialysis (500-HD). In the whole group, mean 500-HD interval was 15.5 +/- 10.5 months (mean +/- SD). Linear regression analysis showed a weak correlation between MAP and 500-HD (r = -0.20; p less than 0.02). Significant correlation could not be found in subgroup analysis of patients with chronic glomerulonephritis (n = 68), angionephrosclerosis (n = 22), or polycystic kidney disease (n = 35). A significant negative correlation between MAP and 500-HD was demonstrated in the subgroup of 42 patients with chronic interstitial nephritis (r = -0.47; p less than 0.002). Stratification analysis according to MAP values did not reveal significant differences in 500-HD interval except for the patients with MAP less than or equal to 95 mmHg whose 500-HD was 24.7 +/- 18.4 months versus 14.7 +/- 9.0 months in patients with MAP greater than 95 mmHg (p less than 0.001). These results suggest that MAP may not be a determinant factor in the progression rate of advanced CRF, except possibly for patients with chronic interstitial nephritis and/or very low MAP.
系统性动脉压对晚期慢性肾功能衰竭（CRF）患者肾功能进展速率的影响仍存在争议。在一项对167例具有明确原发性肾病特征患者的回顾性分析中，我们分析了经治疗或未经治疗的平均动脉压（MAP）对CRF进展速率的影响，CRF进展速率通过血浆肌酐达到500μmol/l至首次反复血液透析（500-HD）的时间间隔来判断。在整个研究组中，平均500-HD间隔为15.5±10.5个月（平均值±标准差）。线性回归分析显示MAP与500-HD之间存在弱相关性（r = -0.20；p<0.02）。在慢性肾小球肾炎患者（n = 68）、肾血管硬化患者（n = 22）或多囊肾患者（n = 35）的亚组分析中未发现显著相关性。在42例慢性间质性肾炎患者亚组中，MAP与500-HD之间存在显著负相关（r = -0.47；p<0.002）。根据MAP值进行的分层分析未显示500-HD间隔存在显著差异，但MAP≤95mmHg的患者500-HD为24.7±18.4个月，而MAP>95mmHg的患者为14.7±9.0个月（p<0.001）。这些结果表明，MAP可能不是晚期CRF进展速率的决定性因素，可能慢性间质性肾炎患者和/或MAP非常低的患者除外。
