肾动脉狭窄介入治疗的疗效分析

Therapeutic effect of renal artery revascularization on renal artery stenosis

目的评价经皮肾动脉成形术血运重建对于肾动脉狭窄患者的血压、肾功能等方面的影响。方法2004年2月-2008年4月我院收治的肾动脉狭窄患者201例(管腔狭窄≥70%),经肾动脉成形术重建肾动脉血运。其中138例患者术后平均随访(13±10)月,观察其血压、降压药物、肾功能的变化。结果201例患者肾动脉成形术成功率96%。病变动脉管腔直径狭窄率由70%±11%降至12%±10%。术后随访138例患者血压下降有统计学意义(P<0.01),收缩压由(20.1±3.3)kPa降至(18.3±2.1)kPa,舒张压由(10.9±2.0)kPa降至(10.3±1.5)kPa;口服降压药品种减少(P<0.01),由平均(2.4±1.2)种降至(1.8±0.9)种;术后1至23个月发生支架内再狭窄14例,非开口病变是再狭窄的危险因素。结论肾动脉狭窄患者经皮肾动脉成形术的手术成功率高,并有助于此类患者血压的长期控制,支架内再狭窄与肾动脉狭窄病变部位相关。

Objective To observe the effect of renal artery angioplasty on blood pressure and kidney function in patients with renal artery stenosis （RAS）. Methods A total of 201 patients with RAS received percutaneous transluminal renal artery angioplasty/stents （PTRAS）. One hundred and thirty-eight patients were followed up for an average period of 13 ± 10 months to observe changes occurred in their blood pressure, serum creatinine level, and glomerular filtration. Results Renal artery angioplasty was successfully performed in 96% of the 201 patients. The renal artery stenosis rate was decreased from 70% ± 11% to 12%±10% after PTRAS. The blood pressure of 138 followed-up patients was significantly decreased （P 〈 0.01 ）. The number of anti-hypertensive drugs was significantly decreased （ P 〈 0.01 ）. The systolic blood pressure was decreased from （20.1 ± 3.3 ） kPa to （ 18.3± 2.1 ） kPa, while the diastolic systoli pressure was decreased from （ 10.9 ± 2.010） kPa to （3± 1.5 ） kPa. Instent restenosis occurred in 14 patients 1 to 23 months after operation, which was correlated with nonostial stenosis. Conclusion Patients with renal artery stenosis can benefit from PTRAS and instent restenosis is correlated with the type of RAS.