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目的:总结移植肾动脉狭窄患者诊断特点,分析经皮腔内血管成形术(PTA)治疗效果。方法:记录移植肾动脉狭窄患者肾功能、血压、彩超、动脉造影(CTA)的变化特点,并通过自身配对研究分析PTA治疗后临床指标变化情况以判断其疗效。结果:确诊移植肾动脉狭窄患者17例,发生率为1.34%;确诊时血清肌酐(SCr)由143.1±53.7μmol/L升至194.8±80.0μmol/L(P<0.01),估算的肾小球滤过率(eGFR)由52.3±15.6ml/(min·1.73m2)降至36.9±10.4 ml/(min·1.73m2)(P<0.01);58.8%的患者平均动脉压(MAP)升高;移植肾彩超提示动脉狭窄处流速125.9±22.9 cm/s升至331.8±132.7 cm/s(P<0.01),82.4%的患者有动脉狭窄处阻力指数(RI)下降,由0.75±0.07降至0.61±0.17(P=0.001),而小叶间动脉流速及RI无明显变化;所有患者均由CTA确诊后行PTA治疗,13例患者肾功能改善,有效率为76.5%,治疗后肾功能恢复至稳定状态的时间为7~27d,平均14.5±4.8d,另4例无改善或肾功能继续减退。PTA治疗后SCr降至153.0±43.0μmol/L,eGFR升至47.9±16.1 ml/(min·1.73m2),MAP降至93.4±7.2 mmHg,动脉狭窄处流速降至156.3±58.0 cm/s,动脉狭窄处RI升至0.74±0.08,以上指标与动脉狭窄发生前相比除MAP稍低(P=0.005)外,其余均无统计学差异(P>0.05),随访1年效果良好。结论:彩超是筛查移植肾动脉狭窄的重要手段,CTA可用于确诊,但不能忽视造影剂的肾毒性;PTA治疗移植肾动脉狭窄有效率为76.5%,治疗后2周左右肾功能趋于稳定,远期随访效果良好。
OBJECTIVE: To summarize the diagnostic characteristics of patients with renal artery stenosis and analyze the effect of percutaneous transluminal angioplasty (PTA). Methods: The changes of renal function, blood pressure, color Doppler ultrasound and arterial angiography (CTA) were recorded in patients with renal artery stenosis. The changes of clinical indexes after PTA treatment were analyzed by self-matched study to determine the curative effect. Results: The diagnosis of renal artery stenosis in 17 patients, the incidence was 1.34%; diagnosis of serum creatinine (SCr) increased from 143.1 ± 53.7μmol / L to 194.8 ± 80.0μmol / L (P <0.01), estimated glomerular The filtration rate (eGFR) decreased from 52.3 ± 15.6ml / (min · 1.73m2) to 36.9 ± 10.4ml / (min · 1.73m2) (P <0.01). Mean arterial pressure (MAP) increased in 58.8% Transplantation of renal ultrasound showed that the flow velocity of arterial stenosis increased from 125.9 ± 22.9 cm / s to 331.8 ± 132.7 cm / s (P <0.01), and the resistance index (RI) of arterial stenosis decreased in 82.4% from 0.75 ± 0.07 to 0.61 ± 0.17 (P = 0.001), while the interlobular arterial flow velocity and RI had no significant changes. All patients were diagnosed by CTA and treated with PTA. The renal function of 13 patients improved, the effective rate was 76.5%, and the renal function recovered to stable after treatment State of the time for 7 ~ 27d, an average of 14.5 ± 4.8d, the other 4 cases without improvement or renal function continued to decline. SCr decreased to 153.0 ± 43.0 μmol / L and eGFR increased to 47.9 ± 16.1 ml / (min · 1.73 m2) after PTA treatment, MAP decreased to 93.4 ± 7.2 mmHg, arterial stenosis decreased to 156.3 ± 58.0 cm / s, The RI of stenosis increased to 0.74 ± 0.08. There was no significant difference between the above indexes and the pre-stenosis except MAP (P = 0.005) (P> 0.05). The follow-up of 1 year was effective. Conclusion: Color Doppler ultrasonography is an important screening method for renal artery stenosis. CTA can be used for diagnosis, but nephrotoxicity of contrast medium can not be neglected. The effective rate of PTA in treating renal artery stenosis is 76.5%, and renal function tends to be stable after 2 weeks of treatment Long-term follow-up effect is good.