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纤维肌性发育不良致肾血管性高血压的临床特征及诊断治疗 被引量:6

Clinical characteristics and treatment in patients with renovascular hypertension caused by fibromuscular dysplasia
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摘要 目的分析纤维肌性发育不良(FMD)致肾血管性高血压的临床特征及诊断治疗。方法回顾性分析北京协和医院2006—2017年确诊的39例FMD致肾血管性高血压患者的临床资料。结果 39例患者,男女比例1∶3,就诊平均年龄22岁,均以早发中重度高血压就诊,67%患者病程中伴随低钾血症。影像学多表现为肾动脉中远段节段性狭窄,多为单肾、主干中远段血管受累。以肾动脉血管造影提示肾动脉狭窄为诊断金标准。比较立位血浆肾素活性、肾动脉超声、肾血流灌注及功能动态显像、肾动脉计算机断层扫描血管造影对FMD的诊断敏感性,分别为:74%、84%、72%及95%。球囊扩张术治疗完全缓解率为38%,部分缓解率为45%,无效率17%。结论 FMD致肾血管性高血压患者常见于年轻女性,呈早发中重度高血压,以肾动脉主干中远段节段性狭窄多见。球囊扩张术为治疗首选,疗效肯定。 Objective To analyze the clinical characteristics of patients with renovascular hypertension caused by fibromuscular dysplasia. Methods Clinical data of 39 cases with renovascular hypertension caused by fibromuscular dysplasia treated in Peking Union Medical College Hospital from 2006 to 2017 were retrospectively reviewed. Results The mean age of the 39 patients was 22 years old, and the ratio of males and female was about 1∶3 (10 males and 29 females). All patients presented with early-onset hypertension, and 67% of them had hypokalemia. Middle and distal segmental stenosis in truck of renal artery were most frequently found, and involved single kidney. Compared to angiography, the gold standard for diagnosis of renal artery stenosis, the diagnostic sensitivity of plasma renin activity in upright position, renal artery ultrasound, renal blood perfusion and renal function dynamic imaging, and renal artery CTA were 74%, 84%, 72% and 95%, respectively. After the treatment of percutaneous balloon angioplasty, the rate of complete remission was 38%, the partial remission rate was 45%, and the inefficiency was 17%. Conclusions Renovascular hypertension caused by fibromuscular dysplasia commonly occurs in young women with the characteristics of early-onset moderate to severe hypertension, and mostly involves middle and distal segment in the renal artery. Percutaneous balloon angioplasty is the first choice for treatment.
作者 崔云英 王芬 童安莉 张响华 李玉秀 CUI Yun-ying;WANG Fen;TONG An-li;ZHANG Xiang-hua;LI Yu-xiu(Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of the People’s Republic of China, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730;Department of Emergency, Affiliated Hospital of Weifang Medical University, Weifang 261000;Department of Endocrinology, Yueyang People s Hospital, Yueyang 414000, China)
出处 《基础医学与临床》 CSCD 2019年第3期381-384,共4页 Basic and Clinical Medicine
基金 中国医学科学院医学与健康科技创新工程重大协同创新项目(2017-I2M-1-001)
关键词 纤维肌性发育不良 肾血管性高血压 临床特征 诊断 治疗 fibromuscular dysplasia renovascular hypertension clinical features diagnosis treatment
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