卡托普利肾动态显像联合计算机断层血管成像诊断肾血管性高血压的临床应用研究

Clinical application of captopril renal scintigraphy combined with computed tomography angiography in the diagnosis of renovascular hypertension

目的评价卡托普利肾动态显像(CRS)联合计算机断层血管成像(CTA)诊断肾血管性高血压(RVHT)的诊断价值。方法回顾性分析2019年1月—2020年12月在三门峡市中心医院就诊并被高度怀疑为RVHT住院的高血压患者200例,对其进行肾动脉CTA、CRS以及肾动脉数字减影血管造影(DSA)检查,肾动脉CTA提示肾动脉狭窄(RAS)后,以DSA提示RAS≥70%作为RVHT的诊断标准,进行CRS评估肾动脉血流动力学变化,分析CRS、CTA及二者联合诊断RVHT的灵敏度、特异度、阳性预测值和阴性预测值。采用Kappa检验评估CTA与DSA诊断RVHT的一致性。结果CTA诊断RVHT的灵敏度95.45%(105/110),特异度87.78%(79/90),阳性预测值90.52%(105/116),阴性预测值94.05%(79/84);CRS诊断RVHT的灵敏度97.27%(107/110),特异度92.22%(83/90),阳性预测值93.86%(107/114),阴性预测值96.51%(83/86);CTA联合CRS诊断RVHT的灵敏度93.64%(103/110),特异度100.00%(90/90),阳性预测值100.00%(103/103),阴性预测值92.78%(90/97)。CTA联合CRS与DSA诊断RAS具有较好的一致性(Kappa=0.930,P<0.001);CTA联合CRS诊断RVHT的特异度、阳性预测值较CTA高(P<0.05)。结论CRS联合CTA可显著提高RVHT的临床诊断。

Objective To evaluate the diagnostic value of captopril renal scintigraphy(CRS)combined with computed tomography angiography(CTA)in the diagnosis of renovascular hypertension(RVHT).Methods We made a retrospective analysis of the data of 200 hospitalized patients who were highly suspected with RVHT and admitted to Sanmenxia Central Hospital from January 2019 to December 2020.Their renal arteries were examined by means of CTA,CRS and digital subtraction angiography(DSA).After renal artery CTA indicated renal artery stenosis(RAS),DSA indication of RAS≥70%was regarded as the diagnostic criteria of RVHT.CRS was conducted to evaluate the hemodynamic changes of renal artery.Then we analyzed the sensitivity,specificity,the positive predictive value and negative predictive value of CRS,CTA and their combined diagnosis of RVHT.Kappa test was used to evaluate the consistency of CTA and DSA in the diagnosis of RVHT.Results The sensitivity,specificity,positive predictive value and negative predictive value of CTA in the diagnosis of RVHT were 95.45%(105/110),87.78%(79/90),90.52%(105/116)and 94.05%(79/84),respectively.Those of CRS were 97.27%(107/110),92.22%(83/90),93.86%(107/114)and 96.51%(83/86),respectively.And those of CTA combined with CRS were 93.64%(103/110),100.00%(90/90),100.00%(103/103)and 92.78%(90/97),respectively.CTA combined with CRS had a good consistency with DSA in diagnosis of RAS(Kappa=0.930,P<0.001).However,the combination of CTA and CRS had higher specificity and positive predictive value than CTA in diagnosis of CRS(P<0.05).Conclusion CRS combined with CTA can significantly improve the clinical diagnosis of RVHT.