粥样硬化性肾动脉狭窄的腔内治疗及术前评估

Endovascular treatment and preoperative assessments of atherosclerotic renal artery stenosis

目的评价腔内治疗粥样硬化性肾动脉狭窄(ARAS)的效果,探讨术前评估指标。方法回顾性分析2008年1月至2016年5月海南省人民医院血管外科应用经皮肾动脉支架成形术(PTRAS)治疗的56例单侧ARAS患者的临床资料。检测并比较术前和术后随访期间患者肾动脉狭窄率、阻力指数(RI)、收缩期峰值流速(PSV)、收缩压、舒张压、服用降压药物种数、肾小球滤过率(GFR)、血肌酐(SCr)等指标。根据术后6个月肾功能和/或高血压改善情况将患者分为有效组42例和无效组14例,比较两组患者术前各项指标。结果本组56例患者成功完成PTRAS;术后6个月随访结果显示,治疗侧肾动脉狭窄率(13.7±1.3)%、RI(0.61±0.07)、PSV(85.7±10.8)cm/s、收缩压(135.1±9.2)mm Hg、舒张压(87.9±7.4)mm Hg、服用降压药物(1.6±0.4)种、SCr(132.3±20.8)μmol/L、GFR(58.5±6.0)m L/min,分别与术前对比,除舒张压以外的其他各项指标均显著性改善,差异均有统计学意义(P<0.05);有效组和无效组患者术前的高血压病程、收缩压、SCr、GFR、血管紧张素(Ang)Ⅱ浓度、合并糖尿病等指标比较,差异均有统计学意义(P<0.05)。结论 PTRAS治疗ARAS具有较好的总体疗效,而术前评估相关指标有助于预测PTRAS的个体疗效。

Objective To investigate the effect of endovascular treatment and preoperative assessment methods for atherosclerotic renal artery stenosis（ARAS）. Methods The clinical data of 56 patients with unilateral ARAS undergoing percutaneous transluminal renal artery stenting（PTRAS）, who admitted to Department of Vascular Surgery of Hainan General Hospital from January 2008 to May 2016, were analyzed retrospectively. Clinical parameters, including the stenosis ratio of renal artery, renal arterial resistive index（RI）, peak systolic velocity（PSV）, systolic blood pressure, diastolic blood pressure, number of antihypertensive drugs required, glomerular filtration rate（GFR）, and serum creatinine（SCr） were measured and compared before and after operation and during follow-up period. All the patients were divided into the effective group（42 cases） and the ineffective group（14 cases） according to the postoperative change of renal function and/or hypertension. The clinical variables before operation were compared between two groups. Results PTRAS was successfully performed in all the 56 patients. The follow-up results at 6 months after operation showed that the stenosis ratio of renal artery, RI, PSV, systolic blood pressure, diastolic blood pressure, number of antihypertensive drugs used, GFR, SCr were（13.7±1.3）%,（0.61±0.07）,（85.7±10.8） cm/s,（135.1±9.2） mm Hg,（87.9±7.4） mm Hg,（1.6±0.4）,（58.5±6） m L/min,（132.3±20.8） mol/L, respectively. Except for diastolic blood pressure, all the observed parameters of the patients were markedly improved after the operation, and all differences between preand post-operative parameters reached statistical significance（all P〈0.05）. Comparison of the clinical variables before operation between the effective group and the ineffective group showed that there was significant difference in the history of hypertension, systolic blood pressure, SCr, GFR, Ang Ⅱ level and associating with diabetes（all P〈0.05）. Conclusion PTRAS has satisfactory clinical efficacy for ARAS, and preoperative assessments of related indicators are helpful to predict effect after PTRAS.