卡托普利肾动态显像诊断肾血管性高血压的应用研究  

Application of captopril renal scintigraphy in diagnosis of renovascular hypertension

作　　者：刘莉[1] 王梅[1] 

机构地区：[1]北京大学第一医院肾内科,北京100034

出　　处：《中国综合临床》2005年第11期994-997,共4页Clinical Medicine of China

基　　金：卫生部临床学科重点项目(20010913)

摘　　要：目的评价卡托普利肾动态显像(CRS)对肾血管性高血压(RVHT)的诊断价值。方法32例患者行肾动脉数字减影血管造影或核磁共振血管成像,并同期行CRS检查,评价CRS诊断RVHT的敏感性和特异性,并对其影响因素进行分析。结果肾动脉狭窄(RAS)组(RAS≥50%)18例,对照组(RAS<50%)14例。①CRS诊断RVHT的敏感性和特异性分别为88.9%和64.3%。②在CRS的诊断参数中,以卡托普利介入后的峰时、摄取率、肾小球滤过率(GFR)、双侧摄取率比值和双侧GFR比值有很好的诊断价值。③在肾功能轻度损害时,CRS诊断RVHT的准确性高于肾功能正常组。而且CRS对于RVHT诊断的敏感性随RAS程度的增加而增加,当RAS≥90%时,CRS检查的敏感性为100%。④在所有接受CRS检查的患者中,未出现明显的低血压情况,亦无任何不适主诉。结论CRS是一个安全灵敏、方便实用的RVHT诊断方法。但有待大样本前瞻对照研究对其诊断价值进行更深入的分析。Objective To evaluate the diagnositic value of captopril renal scintigraphy （CRS） for the diagnosis of renovascular hypertension （ RVHT）. Methods 32 cases underwent renal artery digital subtractive angiography or magnetic resonance angiography while CRS examination was carried out at the same time. The sensitivity and the specificity of CRS for the diagnosis of RVHT were evaluated and the influence factors were analyzed. Results There were 18 cases in renal artery stenosis （RAS） group （ RAS t〉 50% ） and 14 cases in control group （ RAS 〈 50% ）. The sensitivity and specificity of CRS for the diagnosis of RVHT were 88.9% and 64.3% respectively. In captopril-enhanced scintigraphy,peak time, uptake, ratio （UR） ,glomerular filtration rate （GFR） and the ratio of bilateral UR and GFR were all correlated with the degree of the renal artery stenosis. The accuracy of CRS for the diagnosis of RVHT was higher in patients with mild abnormal renal function than those with normal renal function. Meanwhile the sensitivity of CRS for the diagnosis of RVHT was increased with the worsening of RAS. The sensitivity of CRS for the diagnosis of RVHT was 100% when RAS ≥90%. No significant hypertension or uncomfortable symptoms happened during CRS examination. Conclusion Captopril renal scintigraphy is a safe, sensitive and convenient method for the diagnosis of renovascular hypertension. More cases are needed for further evaluation of captopril renal scintigraphy on the diagnosis of renovascular hypertension.

关 键 词：肾动脉狭窄 肾血管性高血压 卡托普利肾动态显像 

分 类 号：R544.1[医药卫生—心血管疾病]