肾动态显像在动脉粥样硬化性肾动脉狭窄支架置入治疗中的价值

目的 探讨99Tcm-DTPA肾动态显像评价和预测经皮腔内肾动脉支架置人术(PTRAS)治疗动脉粥样硬化性肾动脉狭窄(ARAS)的疗效.方法 成功接受PTRAS治疗的单侧ARAS患者76例,分别于术前2周内和术后6个月进行99Tcm-DTPA肾动态显像,利用Gates法测定患侧GFR.根据肾动脉造影结果将狭窄程度分为轻度(50％～69％)、中度(70％～89％)、重度(≥90％)狭窄;根据术前GFR测定结果将患肾功能分为Ⅰ级(GFR≥30 ml/min)、Ⅱ级(15 ml/min≤GFR＜ 30 ml/min)和Ⅲ级(GFR＜ 15 ml/min).通过对比患者术前与术后6个月肾GFR与血压变化情况对PTRAS进行疗效判定.采用SPSS 13.0软件对数据分别进行t检验、x2检验、Fisher精确概率法检验和多元logistic回归分析.结果 术前重度狭窄患者患肾GFR低于轻中度狭窄患者(19.48±11.56)ml/min与(26.79±15.34) ml/min,t =2.262,P=0.027].PTRAS术后血压改善者占32％( 24/75),无变化者占68％(51/75).术前患肾功能为Ⅰ、Ⅱ级患者术后高血压改善率为39.62％( 21/53),高于肾功能为Ⅲ级患者的13.64％ (3/22),x2=4.825,P=0.028;多因素分析示术前患肾功能分级是影响患者术后血压改善的惟一因素(OR=0.465,P=0.032).PTRAS术后GFR改善者占22.37％ (17/76),无变化者占68.42％ (52/76),降低者占9.21％ (7/76);在血压改善组与未改善组患者中,GFR改善的比率分别为33.33％ (8/24)和17.65％ (9/51),但差异无统计学意义(Fisher精确概率检验,P=0.081).结论 肾动态显像可以客观评价单侧ARAS患者PTRAS术后患肾GFR变化,并可预测术后血压改善情况.

Renal dynamic imaging for the treatment assessment of renal artery angioplasty and stenting in pa-tients with atherosclerotic renal artery stenosis

Objective To investigate the value of renal dynamic imaging with ^99Tc^m-DTPA on the evaluation and prediction of the outcome after percutaneous transluminal renal artery angioplasty and stenting （PTRAS） in patients with atherosclerotic renal artery stenosis （ARAS）. Methods Seventy-six patients with unilateral ARAS underwent PTRAS successfully. All the patients received baseline renal dynamic ima- ging within 2 weeks before the surgery and follow-up imaging 6 months after PTRAS. GFR （ per 1.73 m^2 of body surface area） of kidney with ARAS was measured with the Gates method ARA was classified as mild teriograpy before the surgery.GFR milA（50%-69%）, moderate （70%-89%）, and severe （ I〉90% ） stenosis according to the results of renoar- teriography before the surgery. GFR was graded as I （ GFR≥30 ml · min -1 ）, 1/（ 15 ml · min ^-l≤GFR 〈 30 ml·min^-1 ） and 111 （GFR 〈 15 ml· min^-1 ）, on the baseline dynamic imaging. Blood pressure was al- so measured before and after the surgery. The t test, X^2 test, Fisher exact test and multiple logistic regression analysis were used for statistical analysis with SPSS 13.0. Results The baseline GFR of kidney with mildand moderate ARAS was significant higher than that with severe stenosis （（26.79 ± 15.34） vs （19.48 ± 11.56） ml · min^-1 , t =2. 262, P =0.027）. The blood pressure was improved in 32% （24/75）, and not changed in 68% （51/75） of patients. Improvement of blood pressure was observed in 39.62% （21/53） of patients with a baseline GFR≥15 ml · min^-1 , and in 13.64% （3/22） of patients with a baseline GFR 〈 15 ml · rain-1 （X^2 = 4. 825, P = 0. 028 ）. Using multivariate analysis, baseline GFR≥15 ml ^-1 min^-1 was the only predictor of blood pressure improvement （ OR = 0. 465, P = 0. 032 ）. GFR in kidney with ARAS was improved in 22.37% （17/76）, stable in 68.42% （52/76）, and worse in 9.21% （7/76） of patients.The 33.33% （8/24） and 17.65% （9/51） of patients with and without blood pressure improvement, respectively, achieved GFR improvement. However, the difference was not statistically significant （ Fisher exact test, P = 0. 081 ）. Conclusion Renal dynamic imaging with ^99Tc^m-DTPA is a useful method for the evaluation and prediction of the therapeutic effect of PTRAS in patients with ARAS.