大动脉炎肾动脉狭窄/闭塞的介入治疗及临床观察

目的 评价大动脉炎肾动脉狭窄或闭塞介入治疗的疗效.方法 将白求恩国际和平医院血管外科2011年3月至2011年8月入住的53例大动脉炎肾动脉狭窄/闭塞的患者作为研究对象,53例患者接受综合性介入治疗,即对于大动脉炎肾动脉闭塞（RAO）患者,首先采用肾动脉穿通术,开通成功后接受肾动脉形成术或肾动脉支架植入术.对于大动脉炎肾动脉狭窄（RAS）患者,首选肾动脉形成术进行治疗,对于效果不理想者采用肾动脉支架植入术.随后对介入治疗成功率以及术前、术后1个月、术后6个月的血压和肾功能指标进行统计分析.结果 33例RAO患者中,30例行肾动脉穿通术成功后接受了肾动脉形成术或肾动脉支架植入术;3例肾动脉穿通术未成功;介入治疗成功率为90.9%.20例RAS患者,16例成功接受了肾动脉形成术;另外4例肾动脉形成术不理想,随后接受了肾动脉支架植入术;成功率为100%.综合介入治疗的成功率为94.3%.随访结果显示,术后1个月和6个月的收缩压和舒张压相对于术前均有显著降低（P＜0.05）,而术后1个月和术后6个月相差不大（P＞0.05）;血清肌酐水平在术后1个月和术后6个月下降到手术前的80%左右,肾小球滤过率也显著升高（P＜0.05）,而术后1个月和术后6个月相差不大（P＞0.05）.结论 采用综合介入治疗法治疗大动脉炎肾动脉患者的疗效显著,可在今后治疗中推广使用.

Interventional Treatment and Clinical Observation of Takayasu Arteritis Renal Artery Stenosis/Occlusion

Objective To evaluate the effect of interventional therapy of Takayasu arteritis renal artery stenosis or occlusion. Methods From March 2011 to August 2011,53 patients with Takayasu arteritis renal artery stenosis or occlusion admitted by Bethune International Peace Hospital were included as the research object,which were categorized by Takayasu＇s artefitis type and different intervention treatments were given accordingly, including renal artery stenting in 17 cases, renal artery angioplasty in 18 cases, and renal artery fenestration in 18 cases. After the end of treatment, follow-up was done through visit or telephone access to statistically analyze the patients＇ blood pressure and renal function. Results The success rate of interven-tional renal artery stent implantation was 88.2%, of renal artery formed PCI was 94.4%, of renal artery fen-estration was 88.9%. Blood pressure significantly reduced from preoperative level, the concentration of serum creatinine after 1 month ,6 months of treatment dropped to about 80% of the preoperative value, small ball fil-tration rate increased to the normal value（ P 〈 0.05 ）. Conclusion The effect of using combined interven-tional therapy to treat renal artery in patients with Takayasu＇s arteritis is significant, and can be widely ap-plied in the future.