The Clinical Study Of Dynamic Observation Of Ambulatory Arterial Stiffness Index And Contrast-enhanced Ultrasound In Early Hypertensive Renal Injury

Objective:To investigate the dynamic changes of correlation and clinical value of ambulatory arterial stiffness index(AASI)and contrast-enhanced ultrasound(CEUS)in the assessment of early hypertensive renal injury.Methods:1.Screening of 57 cases with primary hypertension,urinary albumin(UMA)was selected as the index,and all cases of patients were randomly divided as early hypertensive renal injury group(28 cases,mean aged 69.72±7.61 years old,UMA for 30-300mg/24h)and no renal injury group(29 cases,mean aged 69.72±7.61 years old,UMA <30mg/24h).2.All cases were given specific antihypertensive treatment according to the experimental requirements.After 6 months of strict control of blood pressure,the changes and correlation of AASI and right renal CEUS were observed before and after treatment.Then to analyze the correlation between CEUS and AASI.3.Calculation method of AASI: After the effective 24 h hour ambulatory blood pressure monitoring,the regression equation(Diastolic pressure =a+b×diastolic systolic pressure)was used to calculate the regression relationship between diastolic blood pressure and systolic blood pressure.The calculated value of AASI is 1 minus the regression slope B.4.CEUS inspection method: Ask thepatient to take a leftlie,quiet subjects,avoid breathing instability,posture change,choose the right kidney as the maximum longitudinal observation area and the selected area after the fixed probe,start the imaging program.At the same time,the image acquisition was performed at the same time of the contrast agent injection,and the changes of renal echo 5min were observed in real time.The dynamic changes of the images were recorded continuously.5.QLAB quantitative analysis software was used to calculate the time intensity curve(TIC curve): The image of the renal cortex texture interest region was introduced into the QLAB quantitative analysis software,and the TIC curve was obtained by analyzing the microbubble strength of the patients.After statistical processing,the TIC curve can automatically obtain the area under the curve(AUC),curve ascending slope(A),slope of descending curve(α),time to peak(TTP),the derived peak intensity(DPI)and other quantitative parameters.Results:Before treatment,the DPI of hypertensive renal injury group were significantly lower than those in the no renal injury group,while AASI、AUC and A were significantly higher than those in the no renal injury group,the difference was statistically significant(P<0.05).After 6 months of strict control of blood pressure,the AASI of renal injury group was lower than before treatment(P<0.05),but AUC,TTP,DPI,A andα compared with the before treatment,the differences had no statistical significance(P>0.05).After6 months of strict control of blood pressure,the AASI 、 AUC and A of no hypertensive renal injury group were decreased compared with before treatment,while DPI was higher than before treatment(P<0.05).All researchobjects before and after treatment,AASI and AUC were independently correlated(P<0.05).Conclusion:1.AASI can evaluate the vascular function of patients with hypertension,and as a predictor of hypertension target organ damage index,reaction standardized effects of antihypertensive treatment on patients with early renal vascular function and subclinical injury,provide better prediction of early hypertensive nephropathy subclinical target organ damage value.2.As a new kind of high precision and non invasive imaging tool,CEUS can reflect the renal blood flow perfusion in real time,and through renal contrast-enhanced ultrasonography combined with TIC curve can be found early in patients with primary hypertension renal perfusion changes and early renal injury in hypertension to provide a sensitive and reliable index for the discovery and evaluation.3.AASI combined with renal CEUS can be used as a sensitive and reliable indicator for the detection and evaluation of early hypertensive renal injury,Which can reflect the effect of antihypertensive therapy on vascular function and renal perfusion,and become good predictors of arterial stiffness and good potential risk of kidney injury.