分侧肾静脉肾素测定比值与肾血管性高血压术后疗效关系的探讨

目的　通过对经介入或手术治疗的肾动脉狭窄患者 2年的随访 ,探讨分侧肾静脉肾素测定对肾血管性高血压术后疗效的预测价值。方法　单侧肾动脉狭窄性高血压患者 4 2例 ,分别行肾动脉球囊扩张术、支架置放术或血管重建术。术前检测血肌酐和肾血流 ,术中测定分侧肾静脉肾素水平。记录患者术前、术后 1周内、6个月、2 4个月的血压。血压明显改善的标准 :收缩压 (SBP)及舒张压 (DBP)均下降≥ 2 0mmHg(1mmHg =0 .133kpa) ;或DBP下降≥ 10mmHg ,且血压 <14 0 / 90mmHg。 结果　 4 2例患者中 ,术后双侧肾静脉肾素测定比值≥ 2 .0有 19例 ,1.5～ 1.9有 11例 ,<1.5有 12例。术后 1周内血压明显改善者中 ,肾素比值≥ 2 .0有 19例 ,1.5～ 1.9有 8例 ,<1.5有 6例 ;术后 6个月血压明显改善者中 ,肾素比值≥ 2 .0有 17例 ,1.5～ 1.9有 6例 ,<1.5有 4例 ;术后 2 4个月血压明显改善者中 ,肾素比值≥ 2 .0有 15例 ,1.5～ 1.9有 5例 ,<1.5有 2例。结论　测定肾素比值对单侧肾动脉狭窄引起的高血压患者近期 (术后至 2年 )血压的改善有预测价值。     

肾动脉成形术治疗肾血管性高血压

目的 观察肾动脉成形术治疗肾血管性高血压的疗效.方法 选择2006年11月～2010年1月于本院住院的肾血管性高血压患者21例,其中单侧肾动脉狭窄17例,肾动脉单侧完全闭塞1例,双侧肾动脉狭窄3例.均实施肾动脉血管造影术.对病变血管行肾动脉成形术(PTRA),单纯应用球囊扩张术6例,球囊扩张术+支架植入术11例,直接支架植入术3例.结果 本组21例,1例肾动脉闭塞者手术失败,肾动脉成形术技术成功率95.2%.治愈2例(2/20)10%,好转15例(15/20)75%,无效3例(3/20)15%.本组病例均未发生手术并发症.结论 肾动脉成形术治疗肾血管性高血压安全有效.     

经皮经腔动脉成型术治疗大动脉炎23例报告

22例大动脉炎所致肾血管性高血压及1例大动脉炎所致锁骨下动脉狭窄用了经皮经腔动脉成型术(PTA)治疗。PTA对肾动脉大动脉炎所致的狭窄其扩张完全成功和部分成功率达95.5%,对其所致高血压的治愈改善率达82%,1例锁骨下动脉的PTA近期疗效满意。     

经皮腔内肾动脉成形术及自体肾移植治疗肾血管性高血压(附7例报告)

自1980到1986年,我院泌尿外科对4例单纯右侧肾动脉狭窄(RAS)性和3例双侧RAS性高血压病人进行了治疗。7例右侧 RAS皆进行了自体肾移植治疗,其中3例双侧RAS者采用PTA治疗,全部病人术后8天内血压皆恢复正常,随诊10个月到6年,无复发且都恢复工作。1例17岁女孩,术后2年结婚,又2年生一女孩,母女健在血压维持正常。     

自体肾移植治疗肾动脉狭窄所致的肾性高血压

肾动脉狭窄所引起的肾性高血压是常见的症状性高血压之一。近年来,由于肾动脉造影的开展以及对肾性高血压、肾血管手术的进一步研究,使此病的诊断及治疗均有较大提高。 本院泌尿科自1973年1月起,用自体肾移植术治疗肾动脉狭窄所致的肾性高血压,至1978年6月共29例。(其中2例作双侧移植共31次自体肾移植术)。术前所有病例     

老年肾血管性高血压的临床分析

肾血管性高血压由于肾动脉狭窄 ,使肾血流量减少 ,肾素 -血管紧张素 -醛固酮系统激活所引起的血压增高 ,是继发性高血压的常见发病原因。严重的肾动脉狭窄可以导致进行性肾损害 ,甚至肾功能丧失[1] 。因此 ,早期在高危人群中筛选出肾动脉病变具有重要的临床意义。1　对象与方法1.1　一般资料本院在 1997年 4月至 2 0 0 2年 5月期间 ,行冠状动脉造影的高血压患者常规行选择性肾动脉造影 ,在 30例患者中发现有 38支肾动脉狭窄。男性 2 2例 ,女性 8例 ,年龄 5 2岁～ 83岁 ,平均年龄 6 8.9岁± 9.4岁 ,6 5岁以上患者 2 6例 ,高血压病程 1a～ 30a…     

肾血管性高血压(附71例临床分型、治疗及随访)

本文报告了71例肾血管性高血压的临床分型、治疗及随访。根据临床表现、血管造影、手术及病理所见,将患者分成多发性大动脉炎伴肾动脉狭窄、单侧或双侧肾动脉狭窄而无其它血管病变及先天性肾发育不全伴肾血管发育不良三种类型。56例手术治疗,15例药物治疗,对5l例4个月～9年(平均2.6年)的随访结果表明:肾切除术及血管重建术总有效率分另别为82.8%及84.6%,药物疗效较差。本文并对病因、诊断及有关治疗进行了讨论。     

肾交感神经射频消融术治疗高血压犬的适宜消融温度探讨

目的探讨肾交感神经射频消融术治疗高血压的适宜消融温度。方法成年健康杂种犬20只,雌雄不拘,体质量15～25 kg,建立腹主动脉缩窄型高血压模型后,随机分为治疗组(行双侧肾交感神经射频消融术)和对照组(n=10)。治疗组根据预置消融温度随机分为45℃和50℃组(n=5)。20只犬分别于建模前、建模后1(射频消融术前)、2(术后1个月)、3个月(术后2个月)监测收缩压、舒张压和平均动脉压。建模后3个月治疗组复查肾动脉造影。肾动脉行HE染色观察病理改变。结果建模后1个月,治疗组和对照组血压均显著升高(P<0.01)。射频消融术后1月治疗组收缩压显著降低(P<0.05)。射频消融术后2个月,收缩压、舒张压、平均动脉压均明显低于射频消融术前(P<0.05,P<0.01),且显著低于对照组(P<0.05,P<0.01)。治疗组复查造影未发现肾动脉狭窄及其他异常。肾动脉血管壁病理检查结果显示,50℃组血管壁损伤明显比45℃组严重。结论 45℃可以作为肾交感神经射频消融术治疗高血压的常规消融温度。     

冠心病合并高血压患者中肾动脉狭窄发生率

目的 :在进行冠状动脉 (冠脉 )造影且伴有高血压的人群中观察肾动脉狭窄 (Renal Artery StenosisRAS)的发生率 ,并识别 RAS的危险因素。方法 :冠脉造影结束后 ,进行非选择性肾动脉造影。结果 :3a内共入选 2 34例高血压并且行冠状动脉造影患者 ,平均年龄 6 0 .6岁 (2 5岁～ 79岁 ) ,131例患者 (5 5 .9% )存在 RAS,其中 10 0例患者 (42 .8% )存在显著的 RAS(腔径狭窄≥ 5 0 % ) ,31例患者 (13.3% )存在轻度的 RAS(直径狭窄 <5 0 % ) ;10 3例患者存在高血压但没有肾动脉狭窄 (Non- RAS) NRAS约占 4 4 .1%。接受冠脉造影检查且伴有高血压的患者中 ,RAS患病率比较高。结论 :冠心病患者有较高的肾动脉狭窄发生率 ,应该在冠状动脉造影后常规行肾动脉造影 ,特别是在合并有高血压的情况下 ,更应该同时进行肾动脉造影     

移植肾动脉狭窄的诊断和治疗探讨

目 的 探讨移植肾动脉狭窄(TRAS)的临床特点及诊治方法。方 法 回顾我院1999年3月至2009年8月共1084例肾移植患者的临床资料,对移植肾动脉狭窄患者的发病特点及诊治方法进行总结分析。结 果 共1084例肾移植患者,尸体肾移植876例,活体肾移植208例,发生移植肾动脉狭窄共6例,总发生率为0.55%,其中5例发生于尸体肾移植,其发生率为0.57%;1例发生于活体肾移植,其发生率为0.48%。其中5例为供肾动脉与受者髂外动脉行端侧吻合,其发生率为0.57%（5/872）,另1例为供肾动脉与受者髂内动脉行端端吻合,其发生率为0.47%（1/212）。狭窄发生部位：动脉吻合口狭窄4例,移植肾上段动脉1例,肾动脉主干1例。6例患者表现为血压突然升高、常规降压药物疗效欠满意、尿量明显减少、血肌酐进行性升高,均先经彩色多普勒血流显像（CDFI）进行筛查,移植肾主动脉主干或吻合口处峰值流速（Vp）≥300cm/s,其中5例再经CT血管造影（CTA)做出初步诊断,最后通过数字减影血管造影(DSA)确诊,且提示狭窄程度为70%-95%,另1例直接用DSA确诊。5例患者确诊后均通过经皮腔内肾动脉支架置入术（PTRAS）治愈,1例患者先经皮腔内血管成形术(PTA),3个月后再次发生原部位狭窄行PTRAS治愈。6名患者已分别随访0.5、3、6、12、18、40个月,未再出现狭窄,移植肾功能功能良好,血肌酐平均小于140umol/L。结 论 （1）血压及血肌酐升高、尿量减少为TRAS的主要临床表现;（2）CDFI为TRAS的首选筛查手段,CTA和DSA为TRAS可靠的确诊方法,而且可以对血管狭窄部位及程度做出判断;（3）PTA和PTRAS为治疗TRAS的重要方法。     

16层螺旋CT动脉造影对肾血管性高血压病诊断的临床应用

目的探究肾血管性高血压病早期诊断的检查方法,并研究16层螺旋CT动脉造影技术对肾动脉狭窄的检出率。方法收集2011年1月~2012年6月我院收治的疑似肾血管性高血压病患者19例,综合分析患者的血压水平、家族遗传病史,采用16层螺旋CT动脉造影对疑似病例进行检查,分析其应用价值。结果 19例患者经过多层螺旋CT动脉造影检查后,肾血管正常者6例,13例显示不同程度肾动脉狭窄,其中,起始段狭窄9例,肾动脉中端狭窄4例;轻度狭窄2例,中度狭窄4例,重度狭窄6例,血管闭塞1例;局限性狭窄10例,全程性狭窄3例。结论 16层螺旋CT动脉造影能清晰的显示肾动脉主干及分支狭窄程度及范围,值得临床推广应用。     

Renal vein plasma adenosine 3'',5''-cyclic monophosphate in renovascular hypertension.

The concentration of plasma adenosine 3',5'-cyclic monophosphate (cyclic AMP) and plasma renin activity (PRA) were measured concomitantly in blood from both renal veins and in arterial blood in 22 hypertensive patients. In the nine patients with true renovascular hypertension the concentration of plasma cyclic AMP was greater in the venous effluent of the kidney affected by the renal artery stenosis than in that of the unaffected or less affected kidney. The arteriovenous difference in cyclic AMP concentration was less on the affected side in all but one patient. The arteriovenous differences in PRA identified the affected kidney as the source of hyper-reninemia and showed that renin release from the other kidney was suppressed. In the 13 patients with hypertension associated with but unrelated to renal artery stenosis there were no consistent patterns of cyclic AMP concentration or PRA in the venous effluent of the kidneys or of their arteriovenous differences. In renovascular hypertension the venous effluent of the kidney affected by renal artery stenosis contains not only more renin but also more cyclic AMP, owing to either increased cyclic AMP production or decreased excretion or extraction of cyclic AMP by the affected kidney. This unilateral increase in cyclic AMP concentration may become a complementary diagnostic feature of true renovascular hypertension.     

多排螺旋CT对肾动脉狭窄的诊断价值

目的评价多层螺旋CT血管造影（MSCTA）在诊断肾动脉狭窄方面的应用价值,为临床治疗决策的选择提供依据。方法收集于山西省心血管病医院行MSCTA肾动脉CTA检查的患者31例,所有患者均有不同程度的高血压,回顾性分析其肾动脉重建图像,并对其预后进行随访。结果31例受检者中,共发现肾动脉狭窄患者10例,其中4例为两侧起始段重度狭窄,3例为左侧肾动脉狭窄,3例为右侧肾动脉狭窄。随访：10例患者中,6例行支架植入术,顽固性高血压于术后均有所改善。结论肾动脉CTA可以发现不同程度的肾动脉狭窄,并对其治疗方法的选择有一定指导意义。     

Experimental model of renovascular hypertension.

ＥｘｐｅｒｉｍｅｎｔａｌｍｏｄｅｌｏｆｒｅｎｏｖａｓｃｕｌａｒｈｙｐｅｒｔｅｎｓｉｏｎＣａｏＸｉｃａｉ曹喜才，ＨｅＮｅｎｇｓｈｕ贺能树，ＷｕＥｎｈｕｉ吴恩惠，ＢａｉＪｉｎｇｗｅｎ白景文，ＹａｎｇＨａｉｘｉａｎ杨海贤ａｎｄＣｈａｎｇＪｉｗｕ畅继武Ｄｅｐ...     

Effects of renal artery stenting on renal function and blood pressure in patients with atherosclerotic renovascular disease

Objective To study the effects of percutaneous renal artery intervention on renal function and blood pressure in patients with renal artery stenosis. Methods Eighty-seven patients with severe uni- or bi-lateral renal artery stenosis (luminal diameter narrowing ≥70%) and clinical hypertension received renal artery stenting between January 2002 and December 2002. The changes in blood pressure and serum creatinine level and creatinine clearance (CCr) 48 hours after intervention and during 6 months of follow-up were assessed.Results Renal stenting was performed in 98 stenotic arteries of 87 patients, and the procedural success rate was 100%. Serum creatinine level was slightly elevated from (176±21) μmol/L to (179±11) μmol/L (P=0.15) 48 hours after the procedure, but significantly decreased to (149±15) μmol/L at 6 months (P&lt;0.001). CCr was also greatly improved ［(37±11) ml/min before versus (51±8) ml/min at 6 months, P&lt;0.001］. During follow-up, 61% of the patients experienced a normal renal function. Despite conventional medical treatment, systolic and diastolic blood pressures were also significantly decreased after stenting ［(163±23)/(96±13) mm Hg before versus (148±12)/(79±15) mm Hg at 6 months, all P&lt;0.001］, and hypertension was well controlled in 67% of the patients at 6 months’ follow-up.Conclusion Renal artery stenting has a high success rate and is effective in improving renal function and blood pressure for patients with severe renal artery stenosis.     

肾动脉型大动脉炎的外科治疗

肾动脉型大动脉炎造成的难治性高血压及肾功能不全是大动脉炎药物治疗的难点,临床面临难治性肾血管性高血压且肾动脉狭窄程度≥70%时,应积极考虑行外科手术治疗。可选择的治疗方式有开放手术或介入治疗,但目前对于术式的选择尚无明确指南。本文总结了开放手术、球囊扩张术、支架置入术的临床效果、长期通畅率及并发症发生率,旨在为肾动脉型大动脉炎的临床手术术式选择提供参考。     

Renal artery stenosis: a disease worth pursuing

Consider renovascular hypertension (HT) when: Newly diagnosed hypertension presents with features that are atypical of essential hypertension; Resistant hypertension is associated with risk factors for atheroma; or Angiotensin-converting enzyme (ACE) inhibitor or angiotensin-II-receptor antagonist therapy is associated with increasing plasma creatinine levels. Atheromatous renovascular HT can often be managed medically, which includes intensive correction of cardiovascular risk factors. ACE inhibitors are probably second-line antihypertensives for patients with unilateral renal artery stenosis and two kidneys. First-line antihypertensives are diuretics, beta-blockers and calcium-channel blockers. Bilateral renal artery stenosis, or a unilateral stenosis in a patient with only one kidney, is an absolute contraindication to ACE inhibition.     

Evaluation of the Urea Washout Pyelogram and Urography in the Assessment of Renovascular Hypertension

The urea washout (UWT) modification of the intravenous pyelogram was used to study 146 hypertensive patients in order to detect the presence of significant renovascular abnormalities. A positive result was obtained in 55 patients and direct confirmation of main renal artery stenoses by selective renal arteriography was obtained in 26. Bilateral abnormalities were confirmed in seven of the 26 patients. No false-negative results were encountered. The usefulness of this test as a comprehensive screening test is outlined. It demonstrated a high degree of accuracy in the diagnosis of significant unilateral or bilateral main renal artery stenosis in addition to the detection of diffuse intrarenal arteriolar disease. It was of value in the postoperative assessment of operative repair of main renal artery defects. The urea washout test embodies both an anatomical and a physiological approach in the roentgen diagnosis of curable renovascular hypertension. The altered physiology resulting from significant main renal artery stenosis makes possible the use of the urea washout intravenous pyelogram. The value of other forms of intravenous pyelography is described.     

彩色多普勒超声对肾动脉狭窄的诊断价值

目的探讨彩色多普勒超声对肾动脉狭窄(RAS)的诊断价值。方法对35例临床可疑肾血管性高血压患者共70条肾动脉采用彩色多普勒超声检测,并得到肾血管数字减影血管造影(DSA)证实,进行回顾性分析。结果彩色多普勒超声肾动脉检测成功率为94%,诊断狭窄≥50%RAS的正确率为87%、敏感性为91%、特异性为90%。结论彩色多普勒超声可作为诊断具有血流动力学意义的RAS(狭窄≥50%)的有效筛查手段,为临床提供重要的诊断信息。