粥样硬化性肾动脉狭窄介入治疗的临床疗效分析

Clinical Efficacy Analysis of Intervention Treatment for Patients with Atherosclerotic Renal Artery Stenosis

目的分析和观察粥样硬化性肾动脉狭窄(ARAS)患者介入治疗术后的临床疗效及影响因素。资料与方法对50例动脉粥样硬化患者65支肾动脉狭窄行经皮腔内肾动脉成形术(PTRA)(包括球囊扩张术和支架置入术),术后1个月、6个月、12个月、24个月随访血压、抗高血压药用药情况、血肌酐及再狭窄情况。结果 50例患者中,术后1、6、12个月全部成功随访,但术后24个月有15例失访。技术成功率为98%,术后1个月、6个月、12个月、24个月血压分别较术前有明显下降(P<0.05),血压控制的临床有效率(治愈+改善)分别为94%、74%、64%和51%,抗高血压药由术前平均3.5种,术后1个月、6个月、12个月平均下降分别为1种、2种、3种,24个月又恢复到3.5种。血清肌酐值与基础值相比无显著差异,术后6个月肾功能改善、稳定及恶化例数分别为12例(24%)、29例(58%)和8例(16%);术后12个月肾功能稳定及恶化例数分别为39例(78%)和11例(22%);术后24个月肾功能稳定及恶化例数分别为26例(74%)和8例(16%)。术后6个月、12个月、24个月支架内再狭窄发生率分别为6.8%、15%、20%。结论 PTRA是治疗ARAS患者十分安全、有效的方法,技术成功率高,并发症发生率低,可以提高ARAS引起的继发性高血压的控制率,还可以保护和改善患者的肾功能。

Objective To assess the clinical efficacy of interventional therapy in patients with atherosclerotic renal artery stenosis（ARAS） and to analyze factors affecting its efficacy.Materials and Methods A total of 50 consecutive patients with 65 ARAS lesions were included in the study,who received percutaneous transluminal renal angioplasty（PTRA）（including Percutaneous renal artery ballon dilation and Percutaneous renal artery stenting placement）.Blood pressure,administratation of antihypertensive drugs,serum creatinine and recurrent renal artery stenosis follow-up were performed at 1,6,12 and 24 months after interventional treatment in all patients.Results Of the 50 patients,all were successfully followed up at 1,6 and 12 months,but 15 lost at 24 months.The technical success rate of interventional precedure was 98%.Compared with pre-intervention average blood pressure,all follow-rp blood pressures were significantly decreased（P0.05）.The control rate of blood pressure（recovery＋improvement） at 1,6,12 and 24 months after the procedure were 94%,74%,64% and 51%,respectively.The average number of antihypertensive drugs decreased from 3.5 to 1 at 1 months,2 at 6 months and 3 at 12 months later,but at 24 months after the procedure the drug number increased to 3.5 again.Follow-up serum creatinine levels were not significantly different from the baseline level.At 6 months after the procedure,kidney function was improved in 12（24%） patients,stable in 29（58%） patients and deteriorate in 8（16%） patients respectively;at 12 months,kidney function was stable in 39（78%） patients and deteriorate in 11（22%） patients;and at 24 months,kidney function was stable in 26（74%） patients and deteriorate in 8（16%）.The recurrent stenosis rate was 6.8% at 6 months,15% at 12 months,and 20% at 24 months.Conclusion PTRA combined with stent placement procedure is a safe and effective treatment of ARAS,with high technical success rate and low complication rate.The interventional therapy can not only effectively control ARAS-related hypertension,but also preserve and even improve kidney function.