上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (7): 952-.doi: 10.3969/j.issn.1674-8115.2011.07.018

• 论著（临床研究） • 上一篇    下一篇

PTRAS治疗动脉粥样硬化性肾动脉狭窄的临床疗效

吴圣俊1, 张 岚1, 张纪蔚1, 方 华2, 张 皓1, 梁 卫1   

  1. 上海交通大学 医学院附属仁济医院 1.血管外科, 2.超声影像科, 上海 200127
  • 出版日期:2011-07-28 发布日期:2011-07-27
  • 通讯作者: 张纪蔚, 电子信箱: zhangjiwei001@sina.com；张岚, 电子信箱: lucky200207@yahoo.com.cn。
  • 作者简介:吴圣俊（1986—）, 男, 硕士生；电子信箱: wushengjun86@hotmail.com。
  • 基金资助:

    上海市卫生局科研基金（2008111）

Clinical efficacy of PTRAS in treatment of atherosclerotic renal artery stenosis

WU Sheng-jun1, ZHANG Lan1, ZHANG Ji-wei1, FANG Hua2, ZHANG Hao1, LIANG Wei1   

  1. 1.Department of Vascular Surgery, 2.Department of Ultrasound, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-07-28 Published:2011-07-27
  • Supported by:

    Shanghai Municipal Health Bureau Foundation, 2008111

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摘要：

目的 评价经皮腔内肾动脉支架成形术（PTRAS）治疗动脉粥样硬化性肾动脉狭窄（ARAS）的临床疗效。方法 28例接受PTRAS的ARAS患者根据肾动脉狭窄程度分为A组（肾动脉狭窄50%～75%，n= 10）和B组（肾动脉狭窄≥75%，n=18）。统计手术成功率。随访6～18个月，彩色多普勒超声检查PTRAS后肾动脉通畅情况并测量肾动脉主干收缩期峰值流速（PSV），分析两组患者治疗前后血压和肾功能主要指标血清肌酐（SCr）和肾小球滤过率（GFR）的变化。结果 28例PTRAS患者中，治疗成功27例，技术成功率为96.43%。彩色多普勒超声复查显示：术后肾动脉通畅，肾动脉主干PSV显著降低（P<0.05）。A组PTRAS后收缩压显著下降（P<0.05），服用降压药物种类显著减少（P<0.05）；B组治疗前后血压测量值和服用降压药物种类比较差异均无统计学意义（P>0.05）；A组高血压疗效的获益率显著优于B组（P<0.05）。A组PTRAS后SCr 显著降低（P<0.05），GFR分级无明显变化，肾功能获益率100%；B组PTRAS后SCr无明显变化，GFR分级显著下降，肾功能获益率81.25%。结论 PTRAS治疗ARAS创伤小、并发症发生率低。肾动脉狭窄50%～75%的ARAS患者经PTRAS治疗后血压控制良好，肾功能主要指标较为稳定。

关键词: 动脉粥样硬化, 肾动脉狭窄, 肾动脉支架成形术, 肾功能, 高血压

Abstract:

Objective To evaluate the clinical efficacy of percutaneous transluminal renal artery stenting (PTRAS) in treatment of atherosclerotic renal artery stenosis (ARAS). Methods Twenty-eight patients with ARAS treated with PTRAS were divided into group A (50% to 75% of renal artery stenosis, n=10) and group B (≥75% of renal artery stenosis, n=18) according to the severity of renal artery stenosis. The success rate of surgery was obtained. Patients were followed up for 6 to 18 months, the obstruction status of renal arteries was examined, and the peak systolic velocity (PSV) of main renal arteries was measured after PTRAS by color Doppler ultrasound. Besides, the blood pressure and main parameters of renal function such as serum creatine (SCr) and glomerular filtration rate (GFR) were compared before and after treatment in two groups. Results PTRAS was successfully performed in 27 of the 28 patients, with the technical success rate of 96.43%. It was demonstrated by color Doppler ultrasound that the renal arteries were unobstructed, and PSV of main renal arteries significantly decreased after treatment (P<0.05). The systolic pressure significantly decreased, and the number of anti-hypertension medications significantly reduced in group A after PTRAS (P<0.05). There was no significant difference in blood pressure and number of anti-hypertension medications before treatment and after treatment in group B (P>0.05). The overall benefit rate of hypertension in group A was significantly higher than that in group B (P<0.05). After PTRAS, SCr significantly decreased, there was no significant change in GFR grading, and the overall benefit rate of renal function was 100% in group A. After PTRAS, there was no significant change in SCr, GFR grading significantly decreased, and the overall benefit rate of renal function was 81.25% in group B. Conclusion PTRAS is a minimally invasive method in treatment of ARAS, with less complications. Patients with ARAS and 50% to 75% renal artery stenosis may result in better control of blood pressure and stable renal function after treatment with PTRAS.

Key words: atherosclerosis, renal artery stenosis, renal artery stenting, renal function, hypertension