肾动脉狭窄合并高血压及肾功能不全患者行血运重建的中期疗效评价

Mid-term evaluation of renal artery revascularization for the treatment of renal artery stenosis concomitant with hypertension and renal insufficiency

目的评价经皮肾动脉血运重建术(percutaneous transluminal renal artery revascularization,PTRAR)治疗对肾动脉狭窄合并高血压及肾功能不全患者的临床疗效。方法对2011年1月至2015年6月因肾动脉狭窄合并高血压在华中科技大学同济医学院附属同济医院心内科行肾动脉血运重建术的62例患者进行回顾性研究,并对其中18例肾功能不全的患者进行随访观察。结果62例患者共76条肾动脉严重狭窄或闭塞,均成功开通,14条肾动脉仅行球囊扩张,62条肾动脉行支架置入。住院期间未出现任何手术相关并发症;术后24 h血压也有明显的下降[收缩压:(150.8±16.4)mmHg比(132.0±12.8)mmHg;舒张压:(88.6±12.7)mmHg比(80.1±11.1)mmHg,P均<0.05]。术后24 h肾功能不全的18例患者平均血压降至(135.7±16.0)/(83.8±11.4)mmHg。针对18例肾功能不全的患者,术后平均随访26个月,结果发现,与术前相比血压明显下降[收缩压:(138.4±11.8)mmHg比(148.7±9.1)mmHg;舒张压:(88.1±10.7)mmHg比(93.5±9.5)mm·Hg,P均<0.05]。所有62例患者术后服药种数明显减少。18例肾功能不全者中6例(33.3%)治愈,7例(38.9%)改善,5例(27.8%)无变化;术后血清肌酐水平的监测发现9例患者的肾功能好转,6例患者的肾功能未受明显影响,3例患者的肾功能恶化。结论肾动脉血运重建术对肾动脉狭窄合并高血压患者的血压带来明显的获益,但对肾功能的改善效果有待进一步研究。

Objective To evaluate the clinical efficacy of revascularization for the treatment of renal artery stenosis concomitant with hypertension and renal insufficiency. Methods Out of our cath- eter-lab database of 62 patients who received renal artery revascularization from Jan. 201/ to June 2015, 18 cases of renal artery stenosis with hypertension and renal insufficiency were confirmed by re- analysis of angiograms. Clinical presentation, therapeutic management and mid-term outcome were ob- tained from medical files and prospective follow-up was performed. Results Seventy-six arteries had successful revascularization, of which /4 got balloon dilation only and 62 had stents deployed. At a mean period of 26-month follow-up, systolic and diastolic blood pressure was significantly decreased [systolic： （148. 7 ± 9. 1） vs. （138. 4± 11. 8） mmHg; diastolic： （93. 5 ± 9. 5） vs. （88. 1 ± 10. 7） mm- Hg, P〈0. 05], and less antihypertensive drugs were prescribed. Of the/8 renal insufficient patients, 13 had well controlled blood pressure but there was no improvement in the rest 5 patients. Creatinine level significantly decreased in 9 patients, and had no improvement in 6 patients. Unfortunately, 3 pa- tients got even deteriorated renal function. Conclusions Renal artery revascularization has a beneficial effect on blood pressure control for the renal artery stenosis with hypertension. However,long-term prognosis and outcome for the renal function need further observation.