经皮肾动脉支架置入治疗动脉粥样硬化性肾动脉狭窄后分肾功能的变化  

Changes of separate kidney function after percutaneous renal artery stent implantation for treatment of atherosclerotic renal artery stenosis

作　　者：王斌[1] 丁明超[1] 陈晓霞 迟国庆[1] 史瑞娜[1] Wang Bin;Ding Mingchao;Chen Xiaoxia;Chi Guoqing;Shi Ruina(Department of Intervention,Aerospace Center Hospital,Beijing 100049,China;Community Health Service Center in Wanshou Road,Haidian District,Beijing 100037,China.)

机构地区：[1]航天中心医院外周血管介入科,北京100049 [2]北京市海淀区万寿路社区卫生服务中心,100037

出　　处：《中华介入放射学电子杂志》2018年第1期55-59,共5页Chinese Journal of Interventional Radiology：electronic edition

摘　　要：目的:探讨经皮肾动脉支架置入(PTRAS)治疗动脉粥样硬化性肾动脉狭窄(ARAS)患者的临床效果。方法:选取2013年1月1日-2015年12月31日在我院进行PTRAS手术的ARAS患者31例,均为单侧肾动脉狭窄。患者随访12个月,观察PTRAS的成功率,以及血压、降压药种类的变化;应用肾动态显像评估分肾肾小球滤过率(SKGFR)的变化。结果:手术成功率100%,无手术严重并发症。术后3、6、12个月随访,患者的收缩压、舒张压、降压药种类较术前均明显降低,血肌酐较术前均无明显变化。术后3、6、12个月支架侧的SKGFR、总GFR较术前明显升高,而非支架侧SKGFR与术前无明显变化。将支架侧术前SKGFR的值以20 ml/min为界,将患者分为两组,SKGFR≥20 ml/min共15例,SKGFR<20 ml/min共16例,分析两组术前、术后SKGFR的变化情况。研究结果显示对于术前SKGFR≥20 ml/min的患者:支架置入术前、术后3~12个月支架侧的SKGFR差异无统计学意义;对于术前SKGFR<20 ml/min的患者,术后3~12个月支架侧的SKGFR较术前均有增加,差异有统计学意义。结论:PTRAS治疗ARAS手术成功率高,并发症低。支架侧的分肾功能明显改善,肾动脉狭窄侧的SKGFR越小,其术后肾功能改善的越明显。Objective:To investigate the clinical efficacy of percutaneous renal artery stenting(PTRAS)for the treatment of atherosclerotic renal artery stenosis(ARAS).Methods:Totally 31 ARAS patients undergoing PTRAS in Aerospace Center Hospital from January 1,2013 to December 31,2015 were selected,with unilateral renal artery stenosis.All the patients were followed up for 12 months to observe the achievement ratio of PTRAS and changes of blood pressure and antihypertensive drug categories.The changes of single kidney glomerular filtration rate(SKGFR)were evaluated by renal dynamic imaging.Results:The achievement ratio was 100%,without severe complications.All patients were followed up for 3,6 and 12 months after operation.The systolic blood pressure,diastolic blood pressure and antihypertensive drug categories were significantly lower than those before the operation,but there was no significant change in serum creatinine.The SKGFR and total GFR in stent side were significantly higher than those before operation,but there was no significant change in non stent side SKGFR after operation.The patients were divided into two groups according to the preoperative SKGFR value in stent side of 20 ml/min,SKGFR<20 ml/min group(16 cases)and SKGFR≥20 ml/min group(15 cases),and the changes of SKGFR before and after operation were analyzed in two groups.Conclusions:PTRAS has high achievement ratio and low complication rate in the treatment of ARAS.The separate kidney function of the stent side is significantly improved,the smaller the SKGFR of the renal artery stenosis,the more obvious the improvement of the renal function after the operation.

关 键 词：肾动脉狭窄 经皮肾动脉支架置入 肾动态显像 分肾肾小球滤过率 

分 类 号：R692[医药卫生—泌尿科学]