经皮穿刺肾动脉腔内球囊成形术治疗大动脉炎性肾动脉狭窄致肾血管性高血压52例次分析

Percutaneous transluminal renal angioplasty therapy in 52 cases with renal artery stenosis associated with hypertension caused by Takayasu′s disease

目的肾血管性高血压是我国常见的一种继发性高血压,药物治疗效果差,作者采用经皮穿刺肾动脉腔内球囊成形术(PTRA)对52例次大动脉炎所致72支狭窄肾动脉进行治疗以探讨其临床应用价值并进行长期随访。方法在X线引导下,采用Seldinger氏穿刺技术将球囊导管送入狭窄肾动脉腔内充盈膨胀球囊,对狭窄病变施于机械性压力使之扩张开通,恢复肾血流灌注。进行长期随访,定期检查血压、肾脏超声及血尿素氮、肌酐、尿常规,以了解肾脏形态和功能。结果52例次72支狭窄肾动脉开通前后直径平均增加(4.1±1.3)mm,P<0.01(t=12.36)。61支动脉开通前后动脉压差平均降低(11±54)mmHg,P<0.01(t=8.37)。肢体血压:扩张前后右上臂卧位血压平均下降(41±17/24±17)mmHg,[P<0.01(t=8.12)/P<0.05(t=4.16)]。52例次(51例)失访20例,31例患者随访1～11年,平均(6.3±2.0)年,血压较术后平均下降(1.5±20/4±11)mmHg(P>0.5/P>0.5)。结论PTRA治疗大动脉炎所致肾血管性高血压是一种简便、安全、疗效可靠、具可重复性且再狭窄发生率较低的方法。对符合适应证者有条件的医院应将其列为首选疗法。

Objective Renovascular hypertension is a common cause of secondary hypertension in China and often drug-refractory. The technique of percutaneous transluminal renal angioplasty (PTRA) was employed to treat 72 stenosis arteries in 52 cases to evaluate the value of clinical adoption, long-term effect and the restenosis of the PTRA. Methods Under X-ray, the Seldinger′s puncture technique was adopted and balloon catheters were introduced to the culprit artery lumen and blew up with the mechanical pressure to reopen the corresponding stenosed arteries. All the patients were followed up regularly for blood pressure, kindney ultrasonography, blood BUN, creatinine and urine proteins to investigate the corresponding kindney morphology and funcation. Result The 72 branches of stenosed renal arteries in 52 cases were re-patented. The mean diameter was (4.1±1.3) mm after the PTRAs, P<0.01 (t=12.36). The mean pressure gradient pre-and poststenosis in the 61 branches of renal arteries had decreased (11±54) mm Hg after the procedures, P<0.01 (t=8.37). The average right arm pressure decreased by (41±17/24±17) mm Hg, P<0.01 (t=8.12)/P<0.05 (t=4.16). Complete success was achieved in 48 cases and partial success in 4 cases according to the Sos standard.Cure in 41 cases and improve in 11 cases were got by the evaluation of clinical effect standard; 20 cases (one accepted two procedures) were lost follow-up and 31 cases were followed up for 1~11 years with the average (6.3±2.0) years, Limb pressure futher decreased by (1.5±20.4/4±11) mm Hg (P>0.5/P>0.5). Only one patient′s corresponding right renalartery was totally occluded angiographically 5 years later with uncontrolled pressure by drugs and morphological dwindling of the right kindney. Conclusion PTRA is a simple, safe, repeatable and effective technique. Restenosis rate for arteritis after PTRA procedures is quite low. It is suggested that PTRA be the first therapeutical choice for patients with the indications.