卡托普利肾动态显像对老年人动脉粥样硬化性肾动脉狭窄的诊断价值

The role of captopril renal scintigraphy examination in diagnosing the atherosclerotic renal artery stenosis in the elderly

目的评估卡托普利肾动态显像诊断老年人动脉粥样硬化性肾动脉狭窄（ARAs）的价值。方法经肾动脉造影证实的肾动脉正常者22例（对照组）和28例老年ARAS患者（ARAS组）行卡托普利肾动态显像检查，评价卡托普利肾动态显像诊断ARAS的敏感性、特异性，并对其影响因素进行分析。结果卡托普利肾动态显像诊断ARAS的敏感性和特异性分别为71．4％和72．7％，卡托普利肾动态显像的4项诊断指标中，肾小球滤过率下降≥10％诊断的敏感性是46．4％，高于其他3项单项指标（P〈0．05）；特异性为86．4％，与其他3项单项指标比较，差异无统计学意义。卡托普利肾动态显像诊断单侧ARAS的敏感性高于双侧，但差异无统计学意义（分别为85．7％与57．1％，P〉0．05）。肾小球滤过率中度以上降低（60～90ml·min^-1·1．73m^-2）的患者中，卡托普利肾动态显像诊断ARAS的敏感性高于肾小球滤过率轻度降低（〈60ml·min^-1·1．73m^-2）患者（分别为78．9％与55．6％，P〉0．05）。接受卡托普利肾动态显像检查的患者中未发生低血压等不良反应。结论卡托普利肾动态显像是一项较为安全、有效的诊断老年人ARAS的方法；应用二乙三胺五醋酸为显像剂，卡托普利肾动态显像时肾小球滤过率下降≥10％效果较好。

Objective To evaluate the diagnostic value of captopril renal scintigraphy （CRS） in the elderly with atherosclerotic renal artery stenosis （ARAS）. Methods Twenty-two patients without renal artery stenosis and 28 patients with ARAS who underwent captopril renal scintigraphy after arteriography were enrolled in the study. The sensitivity and specificity of CRS for the diagnosis of ARAS were evaluated. Results The sensitivity and specificity of CRS for the diagnosis of ARAS were 71.4% and 72.7% respectively. The sensitivity of glomerular filtration rate decreased ≥10% in captopril renal scintigraphy as the criteria in diagnosing ARAS was 46.4%, which was significantly higher than that of other 3 criteria （all P〈0.05）. The specificity was 86.4% which was not statistically significant （P〉0.05）. The sensitivity of CRS for the diagnosis of ARAS was 57.1% in patients with bilateral renal artery stenosis and 85.7% in patients with unilateral renal stenosis, the difference was not statistically significant （P〉 0. 05）. The sensitivity of CRS on the diagnosis of ARAS in the group of the moderately decreased GFR was not significantly different from the group of mild dcreased GFR （78.9% vs. 55.6%, P〉0.05）. No clinically significant side effects such as hypotension happened during CRS examination in the study. Conclusions Captopril renal scintigraphy is a safe and well accurate examination for the diagnosis of atherosclerotic renal artery stenosis in elderly patients. 10% of decrease in calculated GFR of ipsilateral kidney after captopril intake is the most useful criteria in captopril renal scintigraphy when DTPA is used.