超声造影一站式检查在重度动脉粥样硬化性肾动脉狭窄经皮肾动脉支架置入术中的应用价值  

Clinical Value of One-stop Contrast-enhanced Ultrasound in Stent Placement for Patients With Severe Atherosclerotic Renal Artery Stenosis

作　　者：王思宇[1] 孙由静[1] 马娜[1] 纪献浦 张玥伟 刘志文[1] 王杨[2] 任俊红[1] 李拥军[3] WANG Siyu;SUN Youjing;MA Na;JI Xianpu;ZHANG Yuewei;LIU Zhiwen;WANG Yang;REN Junhong;LI Yongjun(Department of Ultrasound,Beijing Hospital,Institute of Geriatric Medicine,National Center of Gerontology,Chinese Academy of Medical Sciences,Beijing(100730),China)

机构地区：[1]北京医院国家老年医学中心中国医学科学院老年医学研究院超声科,北京市100730 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院医学研究统计中心 [3]北京医院国家老年医学中心中国医学科学院老年医学研究院血管外科

出　　处：《中国循环杂志》2022年第11期1150-1155,共6页Chinese Circulation Journal

基　　金：中央高水平医院临床科研业务费(BJ-2018-198);首都临床诊疗技术研究及转化应用专项(Z211100002921011);中央高水平医院临床科研业务费(BJ-2022-160)。

摘　　要：目的:探讨超声造影一站式检查在重度动脉粥样硬化性肾动脉狭窄经皮肾动脉支架置入术(PRAS)中的应用价值。方法:回顾性分析2017年7月至2021年10月北京医院收治的行PRAS治疗的89例重度动脉粥样硬化性肾动脉狭窄患者,依据狭窄肾动脉(排除术后支架内再狭窄肾动脉)对应的患肾术后6个月核素肾动态显像检测的肾小球滤过率(GFR)的变化,分为肾功能改善组(患肾术后GFR升高≥20%)与对照组(患肾术后GFR升高<20%或降低),应用超声造影诊断肾动脉狭窄程度并对比两组肾皮质血流灌注参数变化。结果:89例患者,术中对比数字减影血管造影(DSA)证实95支肾动脉重度狭窄,术前超声造影诊断出93支重度狭窄,2支中度狭窄,诊断重度肾动脉狭窄准确率为97.9%(93/95)。所有患者手术均成功。术后6个月超声造影诊断支架置入术后再狭窄准确率100%(9/9)。与支架置入术前相比,肾功能改善组(n=27)术后皮质血流灌注参数上升时间、达峰时间均明显减少,峰值强度明显增高,AUC明显增大(P均<0.05);对照组(n=59)术后上升时间、达峰时间、AUC、峰值强度差异无统计学意义(P均>0.05)。两组术前皮质血流灌注参数相比,仅AUC差异有统计学意义(P<0.05)。结论:利用超声造影一站式检查诊断重度动脉粥样硬化性肾动脉狭窄及PRAS术后再狭窄结果可靠,肾皮质血流灌注参数在评估PRAS疗效方面具有一定的临床价值,其中AUC价值更高。Objectives:To explore the clinical value of one-stop contrast-enhanced ultrasound(CEUS)in stent placement for severe atherosclerotic renal artery stenosis(ARAS).Methods:This retrospective analysis included 89 ARAS patients treated with percutaneous renal artery stenting(PRAS)in Beijing Hospital from July 2017 to October 2021.According to the changes of glomerular filtration rate(GFR)measured by radionuclide dynamic renal imaging of the affected kidney with stenosis of renal artery(excluding the postoperative stent restenosis of renal artery)at 6 months after operation,the patients were divided into the renal function improvement group(GFR increase≥20%,n=27)and the control group(GFR increase<20%or not increased,n=59).One-stop CEUS was used to diagnose the degree of renal artery stenosis,and the changes of renal cortical blood perfusion parameters were compared between the two groups.Results:Ninety-five severe renal artery stenosis was confirmed by digital subtraction angiography(DSA)during operation in these 89 patients,93 severe renal artery stenosis and 2 moderate renal artery stenosis were diagnosed by CEUS before operation.The accuracy of CEUS in diagnosing severe atherosclerotic renal artery stenosis was 97.9%(93/95).The operation was successful in all patients.The accuracy of CEUS in diagnosing restenosis after stenting was 100.0%(9/9).Compared with pre-stent placement,postoperative cortical perfusion parameters rise time and peak time significantly decreased,the peak intensity significantly increased,and AUC significantly increased post PRAS in the renal function improvement group(all P<0.05).Compared with pre-stent placement,postoperative rise time,AUC,peak intensity remained unchanged in the control group(all P<0.05).Preoperative cortical perfusion parameter AUC and GFR were significantly higher in the renal function improvement group than in the control group(both P<0.05).Conclusions:The results of CEUS in the diagnosis of severe atherosclerotic renal artery stenosis and restenosis after PRAS are relia

关 键 词：重度动脉粥样硬化性肾动脉狭窄 支架置入术 超声造影 肾皮质血流灌注 

分 类 号：R541.4[医药卫生—心血管疾病]