对不同类型肾动脉狭窄小慢波差异的探讨

Differentiations of Tardus-Parvus pattern among different types of renal artery stenosis

目的：探讨小慢波在不同类型肾动脉狭窄（renal arerty stenosis，RAS）中的超声表现差异。方法：选择经彩色多普勒血流显像检查并经肾动脉造影证实的RAS患者81例，其中大动脉炎性29例，纤维肌性发育不良性22例，动脉粥样硬化性30例。将所有患者分为动脉粥样硬化组和非动脉粥样硬化组，每组又分为轻度狭窄、中度狭窄和重度狭窄三个亚组。测量叶间动脉加速时间（AT）和阻力指数（RI）。结果：肾动脉造影显示肾动脉中度狭窄16条，重度狭窄80条和闭塞15条。对于轻度狭窄组、中度狭窄组或重度狭窄组，AT值在动脉粥样硬化组与非动脉粥样硬化组之间差异无统计学意义（P依次为0．24，0．63，0．41）；而RI值在动脉粥样硬化组与非动脉粥样硬化之间差异有统计学意义（P依次〈0．001，〈0.01，〈0.001）。结论：目前常用的AT测量方法存在不足，不能检测出AT在动脉粥样硬化性与非动脉粥样硬化性RAS之间可能存在的差异，但仍可用于RAS的检查。应针对RAS类型来建立RI的诊断阈值。

Objective To evaluate the differences in Tardus-Parvus pattern among different types of renal artery stenosis（RAS）. Methods A study group of 81 RAS patients confirmed by renal arteriography were examined by color Doppler sonography. These patients included 29 cases of Takayasu arteritis,22 cases of fibromuscular dysplasia and 30 cases of atherosclerosis. They were categorized into atheroscelrotie and non-atherosclerotic groups,and each group were graded into mild,moderate and severe stenotic subgroups. Doppler spectra of interlobar arteries were obtained,and the acceleration time （AT） and resistive index （RI） was recorded. Results Renal angiography revealed 16 moderate RAS,80 severe RAS,and 15 occlusions. No statistically significant differences were found in AT between the atherosclerotic and non-atherosclerotic groups in the mild （ P = 0.24） ,moderate （ P = 0.63） or severe stenotie subgroup （ P = 0.41）. However, statistically significant differences were found in RI between the atherosclerotic and non-atherosclerotic groups in the mild （ P 〈0. 001） ,moderate （P〈0.01） or severe subgroup （ P〈0. 001）. Conclusions The measurement method of AT used widely at present can not differentiate possible differences in Tardus- Parvus waveforms between atherosclerotic and non-atherosclerotic RAS, but it still can be applied to the detection of RAS. Furthermore,different cut off values of RI should be established according to the types of RAS.