肾素-血管紧张素检测在经皮腔内肾动脉成形术中的临床价值

Clinical Value of Renin-angiotensin System Evaluation in Percutaneous Transluminal Renal Angioplasty

目的：探讨经皮腔内肾动脉成形（ percutaneous transluminal renal angioplasty ，PTRA）术前肾素-血管紧张素系统（ renin-angiotensin system ，RAS）检测的临床价值。方法采用回顾性队列研究的方法分析2009年10月～2013年10月76例我院PTRA的病历资料，以高血压危险等级下降为治疗有效的评价标准，评价术前血压分级、RAS水平、肾血流灌注情况、小肾图及肾动脉狭窄程度等指标对PTRA适应证选择和预后的价值。结果 RAS阳性患者发生高血压降级的可能（比值比， odd ratio，OR）是RAS阴性患者的3．927倍（χ2＝4．354，P＝0．037）；与高血压一级相比，高血压二级患者发生高血压降级的可能是4.050倍（确切logistic回归法，P＝0．089），高血压三级患者发生高血压降级的可能为12．424倍（确切logistic回归法， P＝0.016）。其余血流灌注延迟、小肾图、肾动脉狭窄程度等指标在2组间差异均无显著性。结论 RAS检测在PTRA术中具有重要临床价值。不同级别的高血压降级比率明显不同，伴有三级和二级高血压的肾动脉狭窄PTRA术后预后较好。

Objective To discuss the clinical value of renin-angiotensin system （ RAS ） evaluation in percutaneous transluminal renal angioplasty （ PTRA） . Methods A retrospective cohort study was carried out to analyze 76 cases of medical records of PTRA operated from October 2009 to October 2013.We deemed the decrease of high blood-pressure （HBp） risk as effective for the operation, according to which we analyzed the prognostic factors among blood pressure , RAS, renal artery perfusion images , small renogram, and angiography of renal artery . Results There was a 3.927 times of possibility of decreasing grade of HBp at RAS positive patients than that at negative patients （χ2 =4.354, P=0.037）.In contrast to grade Ⅰof HBp, there was a 4.050 times of possibility of decreasing grade at grade Ⅱ of HBp （exact logistic regression method, P=0.089）, and a 12.424 times at grade Ⅲ（exact logistic regression method, P=0.016）.There was no significant difference in other factors such as renal artery delay perfusion , small renogram, or stenosis level of renal artery . Conclusions RAS has important clinical value in PTRA operation .There are different outcomes between different high pressure grades .Renal stenosis complicated with grade III and II high blood pressure has a better prognosis after PTRA .