单侧动脉粥样硬化性肾动脉狭窄经皮支架植入术疗效观察

Clinical efficacy of percutaneous transluminal renal artery stenting in unilateral atherosclerotic renal artery stenosis patients

目的评估肾动脉支架植入术(PTRAS)联合最佳药物治疗单侧动脉粥样硬化性肾动脉狭窄(UARAS)患者的疗效,寻找PTRAS疗效良好的预测指标。方法回顾性分析2011年7月至2015年10月在本院行PTRAS术的UARAS共51例患者的临床资料。根据狭窄侧与非狭窄侧肾素水平比值(RVRR)分为二组:肾血管性高血压组[(RVRR≥1.5),21例,RH组]及原发性高血压组[(RVRR<1.5),30例,EH组],比较PTRAS前后血压及肾功能,并分析肾功能好转的相关因素。结果51例UARAS患者,收缩压由(158±14)mm Hg降至(142±10)mm Hg(P<0.001);舒张压由(87±11)mm Hg降至(83±7)mm Hg(P=0.03)。降压药物应用的种类由(2.7±0.8)种降至(2.4±0.9)种(P=0.07)。肌酐水平由(102±63.4)μmol/L降至(102±57.0)μmol/L(P>0.05)。EH组收缩压、舒张压、降压药物应用的种类数均有明显下降(P均<0.05),EH组仅收缩压明显下降(P<0.05)。术前肾动脉狭窄处收缩期峰值流速(PSV)>300 cm/s并且肾主动脉比率(RAR)>3.74的患者治疗前后收缩压、舒张压、降压药的种类数均有显著下降(P均<0.05);而PSV≤300 cm/s或RAR≤3.74患者仅有收缩压在治疗前后有显著下降(P<0.05)。相关因素分析发现64%肾功能好转患者术前基线尿蛋白<0.6 g/d,肾功能未好转患者仅有23%(P=0.03)。结论PTRAS联合药物治疗可以给UARAS患者血压带来显著益处。RVRR≥1.5、PSV>300 cm/s、RAR>3.74、术前基线尿蛋白<0.6 g/d是PTRAS疗效良好的预测指标。

Objective To evaluate the effect of percutaneous transluminal renal artery stenting(PTRAS) combined with best medication treatment(BMT) on blood pressure and kidney function of unilateral atherosclerotic renal artery stenosis(UARAS) patients through strict selection.To screen predictive index for satisfactory therapeutic effects after PTRAS.Methods The data of 51 UARAS patients from Jul.2011 to Oct.2015 were analyzed retrospectively.According to renal vein renin ratio(RVRR),patients were divided into two groups :renovascular hypertension(RH) group(n =21,RVRR ≥1.5) and essential hypertension(EH) group(n=30,RVRR<1.5).To campare blood pressure and renal function before and after PTRAS,and look for factors of improvement of renal function.Results For 51 UARAS patients,systolic pressure and diastolic pressure were significantly decreased from(158±14) mm Hg to(142±10) mm Hg(P<0.001),and(87±11) mm Hg to(83±7) mm Hg(P=0.03),respectively.The number of antihypertension medications was decreased from 2.7 ±0.8 to 2.4 ±0.9(P =0.07).Serum creatinine level was decreased from(102±63.4) μmol/L to(102 ±57.0)μmol/L(P >0.05),which did not change significantly after the treatment.In RH group,systolic pressure,diastolic pressure and the number of anti-hypertension medications were significantly decreased(P <0.05).However,only systolic pressure was significantly decreased in EH group(P<0.05).In patients with peak systolic velocity(PSV)>300 cm/s and renal to aortic ratio(RAR)>3.74,systolic pressure,diastolic pressure and the number of anti-hypertension medications were significantly decreased(P<0.05).But in the rest patients,only systolic pressure was decreased significantly(P <0.05).For patient with preoperative base urine protein < 0.6 g/d,64% patients′ renal function improved while 23% didn′t(P=0.03).Conclusion PTRAS combined with BMT could remarkably improve the hypertention in strict slected UARAS patients.RVRR ≥1.5,PSV >300 cm/s and RAR >3.74,preoperative urine protein <0.6 g/d were good predictive index for satisfactory therapeutic effects after PTRAS.