最大充血跨狭窄收缩压差指导肾动脉狭窄介入治疗探讨  

Evaluation of interventional therapy for renal artery stenosis with hyperemic systolic gradient

作　　者：杨慎先[1] 王磊[1] 王枫岭[1] 刘新[1] 赵杰娉[1] 

机构地区：[1]河南省胸科医院心内科,河南省郑州市450003

出　　处：《中国心血管病研究》2015年第6期544-547,576,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 评价最大充血跨狭窄收缩压差（HSG）指导肾动脉狭窄介入治疗对预后血压及肾功能的影响.方法 选取2011年3月至2014年6月在我院诊断为高血压并动脉粥样硬化性肾动脉狭窄（ARAS）50％～90％患者65例,年龄48～72（61±10）岁,其中男性45例、女性20例.随机分为2组：HSG指导的介入组（HSG组）32例和肾动脉造影指导的介入组（对照组）33例.将HSG＞20 mm Hg作为HSG组的标准,将肾动脉造影血管直径狭窄率（DS）＞75％作为对照组PCI的标准.观察手术即刻指标、预后血压及肌酐的变化.结果 两组同组内HSG显著大于静息跨狭窄收缩压差（RSG）[（29±6）mm Hg比（18±5）mm Hg,（19±7）mm Hg比（15±4）mm Hg,P＜0.05].HSG组HSG显著高于对照组[（29±6）mm Hg比（19±7）mm Hg,P＜0.05].植入支架后HSG组收缩压、舒张压及血清肌酐在术后1个月、3个月、6个月、12个月、18个月比对照组明显低（P均＜0.05）.多因素回归分析,影响最大的是HSG（OR=1.21,P=0.0001）.结论 HSG在指导肾动脉狭窄介入治疗上优于肾动脉造影,患者获益更大,血压和肌酐改善更明显.Objective To evaluate the influence on blood pressure and renal function by hyperemic sys- tolic gradient （HSG）-guided treatment of interventional therapy for renal artery stenosis. Methods 65 patients aged from 48-72（61±10）years including 45 males and 20 females were selected, who were diagnosed with hypertension and atherosclemtic renal artery stenosis （ARAS） at stenosis rate 50%-90% from March 2011 to June 2014 in our hospital. They were randomly divided into two groups： one was HSG-guided intervention group（HSG group） with 32 patients, the other was renal angiography-guided group （control group） with 33 patients. HSG〉20 mm Hg was used as criterion in HSG group and diameter stenosis （DS）〉75% by renal angiography was used in control group. At last, instant operation index and changes in prognosis blood pressure as well as creatinine were observed. Results Whether in HSG group or in control group, the values of HSG were significantly greater than the ones of resting systolic gradient （RSG） [ （29±6）mm Hg vs （ 18±5 ）mm Hg, （ 19±7 ）mm Hg vs （ 15±4）mm Hg,P〈0.05 ]. There results also showed the values of HSG was obviously higher in HSG group than that in control group[（29± 6）mm Hg vs （19±7）mm Hg,P〈0.05 ]. What＇s more, compared with control group, systolic blood pressure, diastolic blood pressure and serum creatinine all showed clearly lower values measured one month, three months, six months, twelve months and eighteen months after stent implantations in HSG group （each P〈0.05）. In addition, multivariate analysis showed that the impact on HSG is greatest among these indexes （OR=I.21,P=0.0001）. Conclusion HSG is superior to renal angiography on guiding interventional therapy for renal artery stenosis. The blood pressure and serum creatinine improve significantly, which means that patients would benefit more from therapy.

关 键 词：最大充血跨狭窄收缩压差 肾动脉造影 肾动脉狭窄 介入治疗 

分 类 号：R692[医药卫生—泌尿科学]