肾动脉狭窄无创性检查方法的准确性评价  

Evaluation of noninvasive screening methods for renal artery stenosis

作　　者：常桂丽[1] 左君丽 初少莉[1] 高平进[1] 唐晓峰[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院高血压科,200025 [2]上海徐汇区中心医院老年科

出　　处：《中华高血压杂志》2011年第7期658-662,共5页Chinese Journal of Hypertension

基　　金：上海交通大学医学院科技基金(08410702400)

摘　　要：背景肾血管性高血压是常见的继发性高血压,是肾动脉主干或分支狭窄到一定程度而引起的,患病率日趋增长,其与肾功能损害及心脑血管疾病相关,需早期诊断及治疗以改善预后。有创性肾动脉数字减影血管造影(DSA)是诊断肾动脉狭窄(RAS)的"金标准",然而并非是所有RAS患者均需介入治疗,可通过无创性筛查方法对其诊断,但目前对无创性检查方法的评价很少。目的采用"金标准"评价RAS无创性筛查方法的应用价值。方法将行DSA的高血压患者174例按诊断分为肾动脉狭窄组和正常组,分析两组临床特征、继发性醛固酮增多症(继醛)指标、肾脏结构与功能及影像学检查结果,以评价各种方法在筛查RAS中的意义。结果狭窄组激发醛固酮[(303.2±247.7)比(190.4±98.8)ng/L,P=0.018]和肾素活性(PRA)[(5.7±3.2)比(3.9±3.4)μg/(L.h),P=0.001]高于正常组;分侧肾小球滤过率(GFR)差值百分比大于正常组[(0.47±0.28)比(0.27±0.23),P<0.01]。双肾长径差值百分比狭窄组大于正常组[(0.10±0.14)比(0.07±0.08),P=0.047]。肾脏缩小、分侧GFR降低及肾动脉CT血管造影(CTA)/磁共振血管造影(MRA)在诊断RAS的敏感性分别为81.0%、82.7%、90.6%;以动脉粥样硬化积分、激发PRA、激发醛固酮、肾脏大小、分侧GFR为自变量,DSA结果为应变量行二分类logistic回归,结果示激发肾素、分侧GFR对诊断RAS的价值较大,其共同诊断RAS的敏感性为62.3%,特异性83.8%。结论用DSA评价无创性RAS筛查方法,除肾动脉CTA/MRA外,分侧GFR对诊断的价值较高,结合激发肾素可提高RAS的诊断价值。Background Renal artery stenosis（RAS）is the primary cause for renovascular hypertension,a common type of secondary hypertension.The prevalence of renovascular hypertension is reportedly increasing worldwide.Because it induces kidney damage and cardiovascular events,earlier diagnosis and management of RAS are demanded to improve the prognosis of the disease.Although invasive digital subtraction angiography（DSA）is the gold standard for diagnosis of RAS,noninvasive methods are under demanding for patients who do not require invasive therapy at the time.However there is little evaluative assessment on noninvasive methods in literature.Objective To evaluate the clinical significance of selected noninvasive screening methods for diagnosis of RAS assisted with DSA.Methods One hundred and seventy-four hypertensive patients,who had DSA,were divided into two groups：RAS and normal control.Their clinical data,including stimulated aldosterone,secondary hyperaldosteronism and kidney function and imaging,were collected and analyzed for the significance for diagnosis of RAS.Results Stimulated aldosterone was significantly increased in RAS group [（303.2±247.7）ng/L] comparing to that in normal control group [（190.4±98.8）ng/L）（P=0.018）.Stimulated plasma renin activity（PRA）was significantly higher [（5.7±3.2）μg/（L·h）] in RAS group than that [（3.9±3.4）μg/（L·h）] in control group（P=0.001）.The percentage difference of bilateral glomerular filtration rate（GFR）was significantly larger（0.47±0.28）in RAS group than that in control group（0.27±0.23）（P0.01）.The percentage difference of longitudinal diameter between both kidneys was larger in RAS group（0.10±0.14）than that in normal control group（0.07±0.08）（P=0.047）.The diagnostic sensitivity of reduction in kidney size,reduction of GFR and CTA/MRA for RAS was 81.0%,82.7% and 90.6% respectively.In a statistical analysis using a binary logistic regression model,combination of stimulated PRA and GFR demonstrated

关 键 词：肾动脉狭窄 肾血管性高血压 肾素 醛固酮 肾小球滤过率 

分 类 号：R544.14[医药卫生—心血管疾病]