兰州大学机构库 >学院待认领
早期IgA肾病患者血管内皮功能及病理研究
Alternative TitleThe study of endothelial function and pathological in early-stage IgA nephropathy patients
王媛
Thesis Advisor童明辉
2011-05-25
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword血管内皮功能 IgA肾病 高血压 肱动脉 高频超声
Abstract[目的] 应用高频超声评价早期IgA肾病患者血管内皮功能是否受损及损害程度,分析其与肾脏病理损伤及肾小球免疫复合物沉积的关系,探讨超声检测IgA肾病患者血管内皮功能的临床价值。 [方法] 将45例经肾活检确诊的早期IgA肾病患者分为2组,A组:26例血压正常组;B组19例高血压组;应用高频超声检测两组患者的肱动脉充血前后管径变化率,并收集肾活检病理资料进行分析,评价早期IgA肾病患者的血管内皮功能是否受损及损害程度,分析血管内皮功能与年龄、血压、肾脏病理损伤及肾小球免疫复合物沉积的关系。 [结果] 1. B组的内皮依赖性血管舒张功能(flow-mediated dilation,FMD)(4.86±1.97)%低于A组(9.40±1.33)%(P<0.05),肾小球的损伤评分(4.42±1.72)、肾间质的损伤评分(3.56±1.62)高于A组肾小球的损伤评分(3.67±2.11)(P<0.05)、肾小管的损伤评分(2.97±1.61)( P<0.01)。 2. FMD%与收缩压(r=-0.310)、肾小球损伤评分(r=-0.332)、肾间质损伤评分有相关性(r=-0.596)(P<0.05);与年龄(r=-0.283)、舒张压(r=-0.121)无相关性(P>0.05)。 3.肾小球内免疫复合物沉积不同的组间收缩压及FMD不同,Ⅱ组(IgA伴IgG沉积)的收缩压(138.73±13.78)mmHg高于Ⅰ组(仅有IgA沉积)的收缩压(127.86±11.64)mmHg,Ⅱ组的FMD%(5.16±1.23)%低于Ⅰ组的FMD%(6.59±1.35)%,组间差异有统计学意义(P<0.05);Ⅰ组、Ⅱ组、Ⅲ组(IgA伴IgM沉积)、Ⅳ组(IgA伴IgG及IgM沉积)间的舒张压(96.40±8.96mmHg VS 104.86±11.63 mmHg VS 99.58±9.73mmHg VS 101.46±10.31mmHg)无明显差异(P>0.05),Ⅰ组、Ⅲ组、Ⅳ组间的收缩压(127.86±11.64mmHg VS 132.16±12.39mmHg VS 134.59±11.83mmHg)及FMD(6.59±1.35% VS 6.32±1.58% VS 5.98±1.62%)无明显差异(P>0.05)。 [结论] 1.早期IgA肾病高血压患者在肾功能损害之前已经存在血管内皮功能的减低及较高的肾小球、肾小管的损伤程度;2.血管内皮功能减低可促进肾小球和肾小管的损伤。3.伴不同免疫球蛋白沉积的IgA肾病的收缩压和血管内皮功能组间比较有差异性,IgA伴IgG沉积的患者的收缩压较高,血管内皮功能较低。4.高频超声可用于早期检测IgA肾病患者的血管内皮功能。
Other AbstractObjective To evaluation endothelial function in early-stage IgA nephropathy hypertension patients by high-frequency ultrasound and to analysis the relation between endothelial function and diameter with vascular foundation, age, blood pressure, kidney pathological damage for discusses the clinical value of Flow-Mediaied Dilation(FMD) . Metheods 45 cases of diagnosed early-stage IgA nephropathy patients divided into two groups, group A : 26 cases of normal blood pressure; B group :19 cases of hypertension .Two groups of patients detection the base diameter and reactive hyperaemia with brachial artery by high-frequency ultrasound. To evaluation endothelial function in early-stage IgA nephropathy hypertension patients and to analysis the relation between endothelial function and diameter with vascular foundation, age, blood pressure, kidney pathological damage. Results 1.The vascular endothelium-dependence dilation(FMD%)(4.86±1.97)% was lower in group B than that in group A (9.40±1.33)%(P < 0.05), The glomerular damage score (4.42±1.72) was higher in group B than that in group A(3.67±2.11)(P<0.05). The renal tubular injury score(3.56±1.62)was higher in group B than that in group A (2.97±1.61)(P<0.01). The difference had statistics significance. 2. The hemodialysis patients′s FMD% had a high correlation with systolic blood pressure (SBP(r=-0.310)), the glomerular damage score (r=-0.332)and the renal tubular injury score(r=-0.596)(P<0.05);. FMD had no correlated with age (r=-0.283)and diastolic blood pressure (DBP) (r=-0.121)(P>0.05). 3.The SBP and FMD % was different between fore groups which glomerular had different immune complex deposition .Group Ⅱ's SBP (138.73±13.78)mmHg was higher than the group Ⅰ's(127.86±11.64)mmHg,Group Ⅱ's FMD% (5.16±1.23)% was lower than the group Ⅰ's (6.59±1.35)%. The difference had statistics significance(P<0.05).The fore groups had no differente between DBP(127.86±11.64mmHg VS 132.16±12.39mmHg VS 134.59±11.83mmHg)(P>0.05).The SBP was not differente in groupⅠ, groupⅢ and group Ⅳ(6.59±1.35% VS 6.32±1.58% VS 5.98±1.62%)(P>0.05). Conclusions: Early IgA nephropathy hypertension patients was existed lower endothelial function and higher glomerulus and kidney tubule damage befor decline in renal function. The decline of Endothelial function can promote kidney pathological damage. The patients has sedimentary IgG in glomerulus with higher systolic blood pressures a...
URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/222264
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
王媛. 早期IgA肾病患者血管内皮功能及病理研究[D]. 兰州. 兰州大学,2011.
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