The Clinical Research Of Color Doppler Ultrasonography In Monitoring Hemodynamic Changes Of Intrarenal Artery In Hypertention Disorders In Pregnancy

Objective The aim of this research was to observe the hemodynamic changes of intrarenal artery in hypertension disorders in pregnancy by using color doppler ultrasonography,and analyze the correlation between each intrarenal artery blood flow parameter with the corresponding renal biochemical index and vascular endothelial function index,investigate the feasibility and dependability of color doppler ultrasonography combined with blood and urine biochemical indicators in evaluating hypertension disorders in pregnancy,so as to provide reliable theoretical basis for early clinical diagnosis and treatment.Methods 30 patients of gentle preeclampsia(group A),30 patients of chronic hypertension with preeclampsia(group B),30 patients of severe preeclampsia(group C)and30 patients of normal pregnancy(group N)were chosen randomly in obsterical department of South West Medical University Affiliated Hospital from Janury,2016 to Janury,2017.Before drug therapy,blood was drown from the subjects after a night fast and 24 h urine was collected to test blood urea nitrogen(BUN),creatinine(Cr),uric acid(UA),cystatin C(Cys C),kidney injury molecule-1(KIM-1),endothelin-1(ET-1)and homocysteine(Hcy).Then gray scale Two-dimension ultrasound was used to observe the positio,morphous,size,structure and echo of right kidney,color doppler ultrasonography was used to observe the blood flow and detect the peak systolic velocity(PSV),end diastolic velocity(EDV),systolic-diastolic ratio(S/D),pulsatility index(PI),resistance index(RI),acceleration time(AT),systolic acceleration(SA)values of renal main,segmental and interlober artery.Datas of the study used Epidate logged,using SPSS17.0Software to analyze and(x ±s)to express the results,the parameters of different groups were undertaking ANOVA analysis,the parameters between two groups of two were analyzed by LSD analysis,the relevant index was analyzed by Pearson analysis,P<0.05 was regarded as statistically significant.Results(1)The levels of intrarenal artery blood flow parameters.1)Interlober artery,there is no statistical significance between RI,S/D and PI in each group,while the diefferences between PSV,EDV,AT and SA were statistically significant(P < 0.001).Among them,the PSV,EDV,SA of group A,B,C were lower than group N,AT were higher than group N,the diefferences were statistically significant(P < 0.01).Compared with group A,the PSV,EDV,SA of group B,C were lower,AT were higher,the diefferences were statistically significant(P < 0.01).2)Segmental artery,there is no statistical significance between RI,S/D and PI in each group,while the diefferences between PSV,EDV,AT and SA were statistically significant(P < 0.001).Among them,the PSV,DV,SA of group A,B,C were lower than group N,AT were higher than group N,the diefferences were statistically significant(P <0.01).3)Main renal artery,there is no statistical significance between RI,S/D and PI in each group,while the diefferences between PSV,EDV,AT and SA were statistically significant(P < 0.05).Among them,Compared with group N,the EDV,SA of group A,B,C were lower,the diefferences were statistically significant(P < 0.05,P < 0.01 respectively),AT were higher,the diefferences were statistically significant(P < 0.01);The PSV of group B,C were lower than group N,the diefferences were statistically significant(P < 0.01);The PSV of group A was lower than group N,the diefference was statistically significant(P < 0.05);Compared with group A,the SA of group C was lower,AT was higher,the diefferences were statistically significant(P <0.01).(2)The levels of renal function indexs,there is statistical significance between BUN,UA,Cr,KIM-1,Cys C in each group(P < 0.001).Compared with group N,the BUN,UA,Cr,KIM-1,Cys C of group B and group C were higher,the diefferences were statistically significant(P < 0.01);Compared with group N,the KIM-1,Cys C of group A were higher,the diefferences were statistically significant(P<0.01);Compared with group A,the BUN,UA,Cr,KIM-1,Cys C of group B and group C were higher,the diefferences were statistically significant(P<0.01).(3)The levels of vascular endothelial function indexs,there is statistical significance between Hcy,ET-1 in each group(P < 0.001).Compared with group N,the Hcy,ET-1 of group B,C were higher,the diefferences were statistically significant(P <0.01);Compared with group A,the Hcy,ET-1 of group B and group C were higher,the diefferences were statistically significant(P < 0.01).(4)Results of relevant analysis.1)There were nagetive correlation between PSV,EDV,SA of interlober artery and BUN(r=--0.566,-0.482,-0.624 respectively,P<0.01);there was positive correlation between AT of interlober artery and BUN(r=0.553,P<0.01).There were nagetive correlation between PSV,EDV,SA and UA(r=-0.459,-0.411,-0.486 respectively,P<0.01);there was positive correlation between AT and UA(r=0.420,P<0.01);There were nagetive correlation between PSV,EDV,SA and Cr(r=-0.596,-0.531,-0.659 respectively,P<0.01);there was positive correlation between AT and UA(r=0.595,P<0.01);There were nagetive correlation between PSV,EDV,SA and Cys C(r=-0.873,-0.796,-0.792 respectively,P<0.01);there was positive correlation between AT and Cys C(r=0.566,P<0.01);There were nagetive correlation between PSV,EDV,SA and KIM-1(r=-0.901,-0.803,-0.831 respectively,P<0.01),there was positive correlation between AT and KIM-1(r=0.600,P<0.01).2)There were nagetive correlation between PSV,EDV,SA and ET-1(r=-0.863,-0.757,-0.794 respectively,P<0.01);there was positive correlation between AT and ET-1(r=0.546,P<0.01);There were nagetive correlation between PSV,EDV,SA and Hcy(r=-0.915,-0.816,-0.818 respectively,P<0.01);there was positive correlation between AT and ET-1(r=0.562,P<0.01).Conclusion(1)Color doppler ultrasonic technique could observe the changes of intrarenal artery hemodynamic in hypertension disorders in pregnancy,and reflect the severity of the disease tosome extent.The indexs including PSV,EDV,AT,SA of interlober artery were sensitive parameters to reflect intrarenal artery hemodynamic changes in hypertension disorders in pregnancy.(2)Cys C and KIM-1 were sensitive parameters to reflect renal function,which change of levels were correlated with the severity of this disease.They were better than BUN,UA,Cr when to reflect renal injury and changes of intrarenal artery hemodynamic in hypertension disorders in pregnancy.(3)There is correlation between vascular endothelial function and intrarenal artery hemodynamics,ET-1 and Hcy were associated with and conduced to renal artery flow changes.(5)Color doppler ultrasonic technique can comprehensively and objectively jundge the degree of kidney damage when combined with biochemical indicators,which has important clinical value in early diganosing and treating hypertension disorders in pregnancy.