肾动脉狭窄性高血压的临床特点及经皮肾动脉介入治疗的效果分析

Interventional Treatment of Renovascular Hypertension:Clinical Analysis

目的探讨肾动脉狭窄性高血压患者的临床特点及经皮肾动脉介入治疗的效果。方法对10例肾动脉狭窄性高血压患者的临床特点及经皮肾动脉介入治疗的效果进行回顾性分析。结果 10例患者中动脉粥样硬化6例,纤维肌性发育不良3例,大动脉炎1例。10例患者均伴有高血压,其中顽固性高血压8例、急进性高血压2例。肾动脉造影结果显示:6例动脉粥样硬化性肾动脉狭窄患者中4例为双侧肾动脉狭窄,狭窄部位位于左、右肾动脉开口处或近段,狭窄程度80%～90%;1例为右肾动脉狭窄,1例为左侧肾动脉,部位位于肾动脉近段,狭窄程度75%～80%。3例肌纤维发育不良性肾动脉狭窄患者均为单侧肾动脉病变,均为右侧,位于肾动脉远段,狭窄程度80%。1例大动脉炎性肾动脉狭窄患者为双侧肾动脉病变,位于肾动脉近段,狭窄程度85%。所有患者于狭窄病变处行支架植入治疗。4例患者(3例为纤维肌发育不良性,1例为大动脉炎)术后1周内血压恢复正常;其余6例患者中血压较前明显改善。2例术前合并肾功能不全患者术后1周肾功能明显改善。结论肾动脉狭窄性高血压有其特殊的临床特征,经皮肾动脉介入治疗是一种有效的治疗方法。

Objective To explore the clinical characteristics of renovascular hypertension and clinical efficacy of inter-ventional Treatment. Methods The clinical features of renovascular hypertension and the effectiveness of percutaneous renal ar-tery interventional therapy were analyzed retrospectively. Results In 10 patients, 6 had atherosclerosis, 3 had fibremuscular dysplasia, 1 had Takayasu arteritis. All patients accompanied by hypertension, thereinto, 8 had resistant hypertension, 2 had rapidly progressive hypertension. By renal arteriography, in 6 atherosclerosis patients, 4 had bilateral renal artery stenosis （RAS）, located at the opening or near segment, stenosis degree was 80% -90% ; 1 had right RAS, 1 had left, located at near segment of renal artery, stenosis degree was 75%-80%. The 3 fibromuscular dysplasia patients were all unilateral renal artery lesions, on the right, located at distant segment, stenosis degree was 80%. The takayasu arteritis patients was bilateral renal artery lesions, located at near segment, stenosis degree was 85%. All patients were given stent implantation treatment. BP returned to normal in 4 patients within 1 week after operation. The other 6 had remarkable improvement in BP. The 2 patients accompanied by renal dysfunction had obvious improvement 1 week after operation. Conclusion Renal artery stenosis hyperten-sion has its special clinical feature, percutaneous coronary artery interventional therapy is an effective treatment.