Boeri D, Derchi L E, Martinoli C, Simoni G, Sampietro L, Storace D, Ponte L, Calvi C, Repetto M, Robaudo C, Maiello M
Cattedra di Clinica Medica RR, Dipartimento di Medicina Interna, Università di Genova, Italy.
Diabetologia. 1998 Jan;41(1):121-4. doi: 10.1007/s001250050877.
It is currently under debate whether the pathogenesis of end-stage renal failure in non-insulin-dependent diabetes mellitus (NIDDM) is a consequence of microangiopathy alone. The aim of this study was to investigate intrarenal arteriosclerosis and its correlation with kidney function in NIDDM. In 36 diabetic subjects, and in 10 age- and sex-matched healthy control subjects we measured kidney volume and resistive index of the interlobar arteries by duplex Doppler ultrasonography. Clinical and metabolic parameters, renal function and vascular sequelae of the disease were also evaluated. In diabetic subjects resistive index (median 0.72, range 0.54-0.79) was higher than in control subjects (median 0.62, range 0.57-0.66) (2p < 0.002). Kidney volume and resistive index correlated with age (p < 0.004), body mass index (p < 0.001), mean blood pressure (p < 0.001), total and LDL cholesterol (p < 0.01) and creatinine clearance (p < 0.001 and < 0.01, respectively). Kidney volume also correlated with HbA1 (p < 0.01) and resistive index with uric acid (p < 0.01). Lower body macroangiopathy was associated with increased resistive index and reduced kidney volume (2p < 0.05), while upper body macroangiopathy and microangiopathy were not. Our data suggest that macroangiopathy rather than microangiopathy is mainly responsible for impairment of kidney function in NIDDM. The resistive index of interlobar arteries seems to be a reliable marker of intrarenal arteriosclerosis and can be used as a non-invasive, easily available parameter of its evolution.
非胰岛素依赖型糖尿病（NIDDM）终末期肾衰竭的发病机制是否仅为微血管病变的结果，目前仍存在争议。本研究的目的是调查NIDDM患者的肾内动脉硬化及其与肾功能的相关性。我们对36例糖尿病患者以及10例年龄和性别匹配的健康对照者，采用双功多普勒超声测量肾体积和叶间动脉阻力指数。还评估了临床和代谢参数、肾功能以及疾病的血管后遗症。糖尿病患者的阻力指数（中位数0.72，范围0.54 - 0.79）高于对照者（中位数0.62，范围0.57 - 0.66）（P < 0.002）。肾体积和阻力指数与年龄（P < 0.004）、体重指数（P < 0.001）、平均血压（P < 0.001）、总胆固醇和低密度脂蛋白胆固醇（P < 0.01）以及肌酐清除率（分别为P < 0.001和< 0.01）相关。肾体积还与糖化血红蛋白（P < 0.01）相关，阻力指数与尿酸（P < 0.01）相关。下肢大血管病变与阻力指数升高和肾体积减小相关（P < 0.05），而上肢大血管病变和微血管病变则不然。我们的数据表明，在NIDDM中，大血管病变而非微血管病变是肾功能损害的主要原因。叶间动脉阻力指数似乎是肾内动脉硬化的可靠标志物，可作为其进展的无创、易于获得的参数。
