28例动脉粥样硬化性肾动脉狭窄患者血管腔内治疗的临床分析

Clinical analysis of endovascular therapy for 28 patients with atherosclerotic renal artery stenosis

目的评价动脉粥样硬化性肾动脉狭窄患者血管腔内治疗的疗效。方法对28例动脉粥样硬化性肾动脉狭窄患者行血管腔内治疗,随访观察患者血压及肾功能变化情况。结果 28例患者行血管腔内治疗均获成功,其中2例为同时行双侧肾动脉支架置入。随访时间1~29个月,平均随访18个月。28例患者中24例获得随访,血压:治愈8例,改善12例,无效4例;肾功能:改善7例,稳定15例,恶化2例。随访患者血压情况:术后3 d、3个月、9个月患者收缩压、舒张压均低于术前,差异均具有统计学意义(P<0.05);术后18个月患者收缩压、舒张压与术前比较差异均无统计学意义(P>0.05)。随访患者肾功能情况:术后3 d、3个月患者血清肌酐(Scr)与术前比较差异均无统计学意义(P>0.05);术后9、18个月患者血清肌酐均低于术前,差异均具有统计学意义(P<0.05)。结论血管腔内治疗动脉粥样硬化性肾动脉狭窄创伤小,安全性高,可有效降低血压和改善或维持肾功能水平。

Objective To evaluate the efficacy of endovascular therapy for patients with atherosclerotic renal artery stenosis. Methods A total of 28 patients with atherosclerotic renal artery stenosis received endovascular therapy, and changes of blood pressure and renal function were observed during follow-up. Results Endovascular therapy was successful in all 28 patients, and 2 cases were treated with bilateral renal artery stenting. The patients were followed up for 1~29 months, with an average follow-up of 18 months. Among 28 cases, 24 cases were followed-up. Blood pressure： 8 cured cases, 12 improved cases and 4 ineffective cases. Renal function： 7 improved cases, 15 stable cases and 2 deteriorated cases. The blood pressure condition during follow-up： patients had lower systolic blood pressure and diastolic blood pressure in 3 d, 3 months and 9 months after operation than before operation, and the difference was statistically significant（P〈0.05）. Patients had no statistically significant difference in systolic blood pressure and diastolic blood pressure in 18 months after operation than before operation（P〉0.05）. Renal function condition during follow-up： patients had no statistically significant difference in serum creatinine（Scr） in 3 d and 3 months after operation than before operation（P〉0.05）. Patients had lower serum creatinine in 9 and 18 months after operation than before operation, and the difference was statistically significant（P〈0.05）. Conclusion Endovascular therapy shows small trauma and high safety in the treatment of atherosclerotic renal artery stenosis. It can effectively reduce blood pressure and improve or maintain the level of renal function.