肾动脉支架置入术后再狭窄超声评估及危险因素分析

Ultrasound Evaluation and Risk Factors Analysis of Restenosis after Renal Artery Stenting

目的应用血管超声成像技术评估肾动脉支架置入术后再狭窄,探讨导致再狭窄的危险因素。方法收集2013年1月至2020年12月于湖北省第三人民医院住院治疗的患者111例,均经血管超声诊断、数字剪影血管造影进一步证实为肾动脉起始段重度狭窄,并行支架置入术,置入支架111枚。依据肾动脉支架置入术后随访结果将患者分为再狭窄组(24例)和非再狭窄组(87例),比较两组患者的一般临床资料、支架管径、支架长度、支架内收缩期峰值流速(PSV)、肾动脉PSV与腹主动脉PSV比值(RAR)、收缩早期加速时间(AT),以及残余狭窄等参数,探讨支架置入术后发生再狭窄的时间及危险因素。结果术后即刻支架残余狭窄5例(4.5%),术后半年、一年、两年随访发生再狭窄的患者分别为7例(6.3%)、13例(11.7%)、4例(3.6%),累计狭窄率21.6%,其中术后一年再狭窄的比例最高。再狭窄组与非再狭窄组一般临床资料比较,再狭窄组高血压、糖尿病患者比例明显高于非再狭窄组(均P<0.05);再狭窄组PSV、RAR、AT在术后即刻恢复正常后,术后半年、一年、两年又逐渐升高,术后两年增加最明显,PSV高达(295.1±56.0)cm/s、RAR增加至(3.75±1.03),AT值增加至(0.090±0.024)s;非再狭窄组PSV、RAR、AT在术后即刻恢复正常后,术后半年、一年、两年与术前比较差异均有统计学意义(均P<0.05);与术后非再狭窄组比较,再狭窄组合并残余狭窄、术后用药不规律、舒张压升高及术前狭窄等变量比例增加明显,差异有统计学意义(均P<0.05)。结论肾动脉支架置入术后一年再狭窄的比例最高。术后存在残余狭窄、术后用药不规律、舒张压升高及术前狭窄率越高的患者,肾动脉支架置入术后再狭窄的风险增加。

Objective To evaluate restenosis after renal artery stenting by vascular ultrasound imaging and to investigate the related risk factors.Methods This was a retrospective cross-sectional study including 111renal artery stent implantation patients admitted to the Third People's Hospital of Hubei Province from January 2013to December 2020.All of these patients were diagnosed by vascular ultrasound,further confirmed by digital silhouette angiography with severe stenosis of the left or right primary renal artery,and underwent stenting.A total of 111stents were implanted.These patients were divided into restenosis group and non-restenosis group based on results of 2-year follow-up after renal artery stenting.The risk factors for restenosis after stent implantation were investigated by comparing the general clinical data,stent diameter,stent length,peak systolic velocity(PSV),the ratio of PSV of renal artery to PSV of abdominal aorta(RAR),early acceleration time of systolic(AT)and residual stenosis of patients in restenosis group and non-restenosis group.Results Immediate residual stent stenosis occurred in 5patients(4.5%).Restenosis occurred in 7patients(6.3%),13patients(11.7%),and 4patients(3.6%)at 6-month,1-year and 2-year after the operation,respectively.The cumulative stenosis rate was 21.6%,and restenosis rate was the highest at 1-year after the operation.Compared with non-restenosis group,the proportions of hypertension and diabetes in the restenosis group were significantly higher(both P<0.05).In the restenosis group,PSV,RAR and AT returned to normal immediately after the operation,but these parameters gradually increased at 6-month,1-year and 2-year after the operation.The increase was most obvious at 2-year after the operation,PSV increased to(295.1±56.0)cm/s,RAR increased to(3.75±1.03),AT increased to(0.090±0.024)s.There was no significant difference in these three indicators compared with those before operation(all P>0.05).In the non-restenosis group,PSV,RAR and AT returned to normal immediately after the operation,and there were significant differences in PSV,RAR and AT at 6-months,1-year and 2-year after the operation compared with the preoperative values(all P<0.05).Compared with the postoperative non-restenosis group,the proportion of variables such as residual stenosis,irregular postoperative medication,high diastolic blood pressure and preoperative stenosis increased significantly in the restenosis group(all P<0.05).Conclusion The risk of restenosis was the highest at 1-year after renal artery stenting.Postoperative residual stenosis,irregular postoperative medication,high diastolic blood pressure and preoperative stenosis may increase the risk of restenosis after renal artery stenting.