经皮肾动脉介入治疗肾动脉狭窄的远期临床疗效

Long-term clinical effectiveness of renal artery intervention in patients with renal artery stenosis

目的观察肾动脉狭窄患者经皮肾动脉介入治疗对血压及肾功能的远期疗效。方法选取1998年1月至2006年6月在沈阳军区总医院心内科住院诊治的肾动脉狭窄患者120例为研究对象,观察术后72 h及随访5年的血压及肾功能的变化,评价肾动脉介入治疗对肾性高血压、肾功能不全的影响。结果 120例行经皮肾动脉介入治疗的患者肾动脉病变狭窄程度76.1%±19.4%,支架直径(5.8±1.2)mm,支架长(17.1±4.2)mm,支架残余狭窄2.1%±0.5%,介入手术成功率达100%。术前血压(178.7±28.4/100.2±17.6 mm)Hg,术后72 h血压(128.1±14.5/75.1±10.1)mm Hg,随访5年时血压(140.2±18.7/84.4±13.2)mm Hg;术后72 h及5年随访血压值较术前显著下降,差异均有统计学意义(P<0.05)。术后人均服用降压药物比术前明显减少,差异有统计学意义[(2.7±1.0)种vs.(3.5±1.0)种,P<0.05]。术前估算肾小球率过滤(estimated glomerular filtration rate,eGFR)(65.50±24.41)mL/(min.1.73 m2),术后72 h eGFR(61.16±23.36)mL/(min.1.73 m2),术后5年eGFR(64.12±23.30)mL/(min.1.73 m2);术后72 h及术后5年与术前eGFR比较,均差异无统计学意义(P>0.05)。27例肾动脉狭窄合并肾功能异常的患者术前eGFR(35.43±11.66)mL/(min.1.73 m2),术后72 h eGFR(33.86±12.51)mL/(min.1.73 m2),术后5年eGFR(39.10±12.69)mL/(min.1.73 m2);术后5年eGFR较术前呈上升趋势,但与术前比较,差异无统计学意义(P>0.05)。结论肾动脉介入治疗可显著降低肾性高血压患者术后血压,减少应用降压药物种类,对术前肾功能正常者无影响;5年随访观察经皮肾动脉介入治疗对术前肾功能异常者无明显改善。

Objectives To evaluate the long-term effectiveness of renal artery intervention on blood pressure and renal function in patients with renal artery stenosis （RAS）. Methods A total of 120 in-hospital patients with serious RAS undergoing renal artery intervention in Department of Cardiology of Shenyang General Hospital of PLA from January 1998 to June 2006 were analyzed for outcomes. Blood pressure and renal function in 72 hours and 5 years after intervention were observed. Effect of renal artery intervention on renal hypertension and renal inadequacy was evaluated. Results Narrowing rate of the 120 patients was 76.1%±19.4%, diameter of stents was （5.8±1.2） ram, length of stents was （17.1±4.2） mm, residual stenosis rate was 2.1%±0.5%, and success rate of intervention was 100%. Blood pressure in 72 hours was （128.1±14.5/75.1±10.1） mm Hg and （140.2±18.7/84.4±13.2） mm Hg 5 years after intervention, decreased significantly comparing with the preoperative （178.7±28.4/ 100.2±17.6） mm Hg （P〈0.05）. Kind of antihypertensive drugs was decreased significantly after intervention （2.7±1.0 vs. 3.5±1.0, P〈0.05）. There was no significant difference in estimated glomerular filtration rate （eGFR） in 72 hours （61.16 ±23.36） mL/（rain. 1.73 m^2） and 5 years after intervention （64.12±23.30） mL/（min· 1.73 m^2） comparing with the preoperative （65.50±24.41） mL/ （min· 1.73 m^2） （P〉O.05）. For the 27 cases with RAS combined with renal function abnormalities, preoperative eGFR was （35.43±11.66） mL/（min· 1.73 m^2）, eGFR in 72 hours after intervention was （33.86±12.51） mL/（min· 1.73 m^2） , and eGFR in 5 years after intervention was （39.10±12.69） mL/（min· 1.73 m^2）. eGFR value was declined after 5 years comparing with that of preoperative, but it had no significant difference （P〉0.05）. Conclusions Renal artery