肾脏滤过分数对单侧肾动脉狭窄腔内治疗选择的影响  

Effects of Renal Filtration Fraction on Endovascular Treatment Selection for Unilateral Renal Artery Stenosis

作　　者：冯琦琛[1] 李选[1] 栾景源[1] 王昌明[1] 李天润[1] 

机构地区：[1]北京大学第三医院介入血管外科,北京100083

出　　处：《中国微创外科杂志》2017年第1期51-54,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨肾脏滤过分数(filtration fraction,FF)对单侧肾动脉狭窄腔内治疗的影响。方法 2014年5月~2015年11月我们对31例单侧肾动脉狭窄行经皮肾动脉成形支架植入术(percutaneous transluminal renal angioplasty and stent,PTRAS),分析患者术前与术后健侧肾脏、患侧肾脏肾小球滤过率(glomerular filtration rate,GFR)、肾有效血浆流量(effective renal plasma flow,ERPF)、FF变化,观察患者血压(收缩压)和服用降压药种类的变化。结果 31例PTRAS均成功。术前患侧GFR(28.79±12.88)ml/min,明显低于健侧(41.72±14.23)ml/min(t=-3.749,P=0.000);术前患侧ERPF(124.55±49.36)ml/min,明显低于健侧(186.92±43.22)ml/min(t=-5.293,P=0.000)。术后患侧肾脏GFR(30.40±12.85)ml/min,明显高于术前(28.79±12.88)ml/min(t=-2.236,P=0.003);术后患侧肾脏ERPF(137.46±47.00)ml/min,明显高于术前(124.55±49.36)ml/min(t=-5.017,P=0.000);术后患侧FF(22.24±5.52)%较术前(24.93±8.68)%明显降低(更趋近于正常值)(t=2.577,P=0.015)。术后患侧GFR(30.39±12.84)ml/min,仍明显低于健侧(40.31±13.87)ml/min(t=-2.920,P=0.005);术后患侧ERPF(137.46±47.00)ml/min,明显低于健侧(178.25±42.25)ml/min(t=-3.593,P=0.001)。术后患侧FF(22.24±5.52)%与健侧FF(22.52±5.73)%无统计学差异(t=-0.195,P=0.846)。术前FF相对正常的患肾,术后FF(21.45±3.35)%较术前FF(21.77±3.26)%变化较小(t=0.847,P=0.407);术前FF明显升高的患肾,术后FF(27.21±5.34)%较术前FF(36.88±6.00)%明显降低(趋向正常值)(t=3.495,P=0.010)。术前肌酐(96.97±25.81)μmol/L与术后(94.39±22.45)μmol/L无统计学差异(t=0.420,P=0.676)。术后收缩压(144.4±11.1)mm Hg较术前(158.5±13.7)mm Hg明显下降(t=7.804,P=0.000);服用降压药物种类术后(2.6±0.6)种,较术前(3.0±0.5)种明显减少(t=4.655,P=0.000)。结论对于肾动脉狭窄患者,分肾FF是了解肾脏缺血病理生理进程的有益指标。对于单侧肾动脉狭窄患者,术前FF显著增高或FF相对正常,应视为肾动脉支架植入术�Objective To investigate the effects of fraction filtration（ FF） on endovascular treatment for patients with unilateral renal artery stenosis. Methods Percutaneous transluminal renal angioplasty and stent（ PTRAS） was performed in 31 patients with unilateral renal artery stenosis from May 2014 to November 2015. Preoperative and postoperative glomerular filtration rate（ GFR）,effective renal plasma flow（ ERPF）,and renal FF of healthy and diseased kidneys were compared. The blood pressure（ SBP） and antihypertensive drugs use were recorded. Results The PTRAS was successfully accomplished in all the 31 cases.Preoperative ipsilateral GFR [（ 28. 79 ± 12. 88） ml / min] was significantly lower than that of the contralateral [（ 41. 72 ± 14. 23）ml / min,t =- 3. 749,P = 0. 000]. Preoperative ipsilateral ERPF [（ 124. 55 ± 49. 36） ml / min] was significantly lower than that of the contralateral [（ 186. 92 ± 43. 22） ml / min,t =- 5. 293,P = 0. 000]. Postoperative ipsilateral renal GFR [（ 30. 40 ± 12. 85）ml / min] was significantly higher than that before operation [（ 28. 79 ± 12. 88） ml / min,t =- 2. 236,P = 0. 003]. Postoperative ipsilateral renal ERPF [（ 137. 46 ± 47. 00） ml / min] was significantly higher than of the preoperative [（ 124. 55 ± 49. 36） ml / min,t =- 5. 017,P = 0. 000]. Postoperative ipsilateral FF（ 22. 24 ± 5. 52） % decreased significantly as compared with the preoperative level（ 24. 93 ± 8. 68） %（ more close to the normal value,t = 2. 577,P = 0. 015）. Postoperative ipsilateral GFR [（ 30. 39 ± 12. 84）ml / min] was still significantly lower than the contralateral [（ 40. 31 ± 13. 87） ml / min,t =- 2. 920,P = 0. 005]. Postoperative ipsilateral ERPF [（ 137. 46 ± 47. 00） ml / min] was significantly lower than that of the contralateral [（ 178. 25 ± 42. 25） ml / min,t =- 3. 593,P = 0. 001]. No statistical difference was seen between postoperative ipsilateral FF（ 22. 24 ± 5. 52） % and contralateral FF（ 22. 52 ± 5. 73�

关 键 词：单侧肾动脉狭窄 经皮肾动脉成形支架植入术 肾小球滤过率 肾有效血浆流量 滤过分数 

分 类 号：R699[医药卫生—泌尿科学]