开博通肾功能显像对肾血管性高血压介入治疗疗效的预测价值

Evaluation of the value of captopril testing renal scintigraphy in renovascular hypertensive patients for predicting the therapeutic outcome of surgical intervention

目的 探讨开博通肾功能显像（ＣＲＳ）对临床确诊为肾血管性高血压（ＲＶＨ） 患者介入治疗疗效的预测价值。方法 对３３ 例肾动脉造影明确肾动脉狭窄，临床确诊ＲＶＨ 的患者介入治疗疗效和ＣＲＳ结果进行对比分析。ＣＲＳ阳性作为预测ＲＶＨ 介入治疗后高血压治愈或有效控制的指标；ＣＲＳ阴性作为预测ＲＶＨ介入治疗后高血压控制无效的指标。结果 ３３ 例患者中，ＣＲＳ阳性２６ 例，２４例介入治疗有效，其阳性预测值为９２－３ ％ ；ＣＲＳ阴性７ 例，５ 例介入治疗后无效，其阴性预测值为７１－４％ ；准确性为８７－９ ％ 。结论 ＣＲＳ对ＲＶＨ

Objective To evaluate the predicting value of captopril testing renal scintigraphy in renovascular hypertensive (RVH) patients undergoing renal artery intervention Methods Captopril testing renal scintigraphy (CRS) was carried out in 33 patients with renovascular hypertension and proven anatomic renal artery stenosis by digital subtraction angiography or (and) selective renal artery angiography before revascularization Renal scintigraphy was performed 1 h after oral administration of 25 mg captopril and 500 mL water, using either 99 Tc m EC or 99 Tc m DTPA after a baseline study Criteria for diagnosis of RVH: Compared with baseline, ①reduction of clearance rate was more than 10% at 20 min, ②delay of time to peak was more than 1 min, ③ratio of peak activity of left/right kidney less than 0 80, ④involved kidney was smaller (long axis≤9 5 cm and short axis≤6 1 cm) Positive CRS result was obtained if three or more of the indices were abnormal Results Out of 26 patients with positive CRS, 24 patients showed normal or significant reduction of systemic blood pressure; out of 7 patients with negative CRS, 5 patients showed no improvement of blood pressure after revascularization The positive and negative predicting value were 92 3% and 71 4%, respectively, the total accuracy was 87 9% Conclusions Captopril renal imaging is of significant value for predicting the therapeutic outcome of RVH patients after surgical intervention