肾动脉狭窄支架术对肾功能及血压的作用

Effects of renal artery stenting on renal function and blood pressure in patients with atherosclerotic renovascular disease

目的 评估肾动脉支架术对肾动脉狭窄患者肾功能和血压的作用。方法 比较 87例单侧或双侧肾动脉明显狭窄 (管腔内径减少≥ 70 % )行经皮腔内肾动脉支架术患者术前、术后 4 8h及随访期血清肌酐 (SCr)、肾小球滤过率 (GFR)和血压变化。结果 87例患者 (98处病变 )均成功置入肾动脉支架。术后 4 8h平均血清肌酐较术前升高 [术前 (176± 2 1) μmol L和术后 (179± 11) μmol L ,P=0 15 ];术后 6个月随访平均血清SCr显著降低 [(14 9± 15 ) μmol L ,与术前比较 ,P <0 0 0 1],GFR显著增加 [(5 1± 8)ml min与术前 (37± 11)ml min比较 ,P <0 0 0 1],6 1%患者血清肌酐测值恢复正常 ;收缩压及舒张压均显著降低 [术前 (16 3± 2 3) (96± 13)mmHg(1mmHg =0 133kPa) ,术后 6个月 :(14 8± 12 ) (79± 15 )mmHg ,P均 <0 0 0 1]。结论 经皮肾动脉支架术手术成功率高 ,对患者肾功能及控制血压具有明显改善作用。

Objective To study the effect of percutaneous renal artery intervention on renal function and blood pressure in patients with renal artery stenosis. Methods Eighty seven patients with severe uni-lateral or bilateral renal artery stenosis (luminal diameter narrowing ≥70%) and clinical hypertension received renal artery stenting between January 2002 and December 2002. The changes in blood pressure and serum creatinine level and glomerular filtration rate (GFR) were assessed at 48 hours after intervention and at 6 months of follow-up. Results Renal stenting was performed in 98 stenotic arteries of 87 patients, and the procedural success rate was 100%. Forty eight hours after the procedure, serum creatinine level was slightly elevated (176±21 μmol/L before versus 179±11 μmol/L after, P=0.15), but significantly decreased at 6 months′ follow-up(149±15 μmol/L, P<0.001). GFR was also greatly improved (37±11 ml/min before versus 51±8 ml/min at 6 months, P<0.001). During follow-up, 61% of patients experienced a normal renal function. Despite conventional medical treatment, systolic and diastolic blood pressures were also significantly decreased after stenting(163±23/96±13 mm Hg before versus 148±12/79±15 mm Hg at 6 months, all P<0.001), and hypertension was well controlled in 67% of patients at 6 months′ follow-up. Conclusion The procedure of renal artery stenting has a high technical success rate and is effective in improving renal function and blood pressure for patients with severe renal artery stenosis.