卡托普利肾动态显像对肾动脉狭窄的诊断价值

目的探讨卡托普利肾动态显像(肾显像)对肾动脉狭窄的诊断价值.方法回顾分析1993年～2007年我院临床确诊大动脉炎且怀疑有肾动脉受累的110例患者的临床资料.110例患者中男性25例,女性85例,平均年龄为(30.2±10.7)岁.所有患者均进行了肾动脉造影和卡托普利肾显像,并将最终结果分为肾动脉造影正常组(肾动脉无狭窄者,n=33)及肾动脉造影异常组(肾动脉狭窄者,n=77)进行统计分析.结果肾动脉造影证实77例有肾动脉狭窄(≥50%),其中双侧肾动脉狭窄者40例,单侧肾动脉狭窄37例.肾动脉造影异常组的77例肾动脉狭窄患者,73例卡托普利肾显像阳性;肾动脉造影正常组的33例中30例卡托普利肾显像阴性.卡托普利肾显像诊断大动脉炎性肾动脉狭窄的敏感性、特异性和准确性分别为94.8%、90.9%和93.6%.卡托普利肾显像诊断单侧肾动脉狭窄的敏感性为94.6%,诊断双侧肾动脉狭窄敏感性为95.0%.110例患者共220支肾动脉,117支肾动脉造影有狭窄病变,其中104支卡托普利肾显像阳性;103支无明显狭窄的肾动脉中,94支卡托普利肾显像阴性.卡托普利肾显像判断血管病变的敏感性、特异性和准确性分别为88.9%、91.3%和90.0%.结论卡托普利肾显像与肾动脉造影比较对大动脉炎患者肾动脉狭窄有较高的诊断价值,卡托普利肾显像可作为大动脉炎是否累及肾动脉病变的一种无创性筛选诊断方法.     

动脉粥样硬化性肾动脉狭窄与肾功能之间的关系

目的 :评价动脉粥样硬化 (AS)性肾动脉狭窄患者的肾功能及与肾动脉狭窄之间的关系。方法 :10 9例非糖尿病患者经肾动脉造影发现存在AS肾动脉狭窄。根据其狭窄程度将患者分组。测定其肌酐清除率 ,采用单因素方差分析和相关分析判断肾动脉狭窄与肾功能之间的关系。结果 :单侧或双侧肾动脉狭窄 <6 0 %的患者 5 9例 ,肌酐清除率为 (6 7.3± 2 0 .9)ml/min ;单侧肾动脉狭窄≥ 6 0 %的患者 38例 ,肌酐清除率为 (6 5 .4± 18.3)ml/min ;双侧肾动脉狭窄≥ 6 0 %的患者有 12例 ,肌酐清除率为 (6 6 .3± 2 0 .3)ml/min ,各组间肌酐清除率差异无统计学意义 (P >0 .0 5 )。肾动脉的通畅程度与肾功能之间也无相关性 (r =0 .0 2 )。结论 :肾动脉狭窄的严重程度与肾功能之间差异无统计学意义。肾动脉狭窄所致的肾功能不全更有可能是肾实质病变造成的。     

卡托普利肾动态显像对老年人动脉粥样硬化性肾动脉狭窄的诊断价值

该文评估卡托普利肾动态显像对老年人动脉粥样硬化性肾动脉狭窄的诊断价值。方法：经肾动脉造影证实的肾动脉正常者22例（对照组）和28例老年ARAS患者（ARAS组）行卡托普利肾动态显像检查，评价卡托普利肾动态显像诊断ARAS的敏感性、特异性，并对其影响因素进行分析。     

卡托普利肾动态显像对肾动脉狭窄的诊断价值

该文探讨卡托普利肾动态显像(肾显像)对肾动脉狭窄的诊断价值。方法:回顾分析1993—2007年我院临床确诊大动脉炎且怀疑有肾动脉受累的110例患者的临床资料。110例患者中男性25例,女性85例,平     

卡托普利肾动态显像对老年人动脉粥样硬化性肾动脉狭窄的诊断价值

该文评估卡托普利肾动态显像对老年人动脉粥样硬化性肾动脉狭窄的诊断价值。方法:经肾动脉造影证实的。肾动脉正常者22例(对照组)和28例老年ARAS 患者(ARAS 组)行卡托普利肾动态显像检查,评价卡托普利肾动态显像诊断 ARAS 的敏感性、特异     

肾动态显像对肾动脉狭窄的诊断意义

目的　探讨肾动态显像 (肾动态ECT)对临床诊断肾动脉狭窄的预测价值。方法　选取 5 0例临床上确诊冠心病合并高血压并怀疑肾血管性高血压 (RVH )的患者进行肾动态ECT、肾动脉造影等检查。结果　 5 0例病人中经肾动脉造影确诊肾动脉狭窄者 2 4例 ,肾动脉正常者 2 6例。ECT敏感性 75 % ,特异性 73.0 8%。肾动脉狭窄组与肾动脉正常组相比 ,肾动态ECT的各项参数有显著性差异(P <0 .0 1)。结论　对于肾动脉狭窄的诊断 ,肾动态ECT检查是一种有效的无创性检查。     

缺血性脑血管病与肾动脉狭窄的相关性分析

缺血性脑血管病（ICVD）约占全部脑血管病人的70％～80％。缺血性脑血管病患者尤其是合并有高血压、糖尿病时往往伴有肾动脉硬化和狭窄,肾功能会受到不同程度损害。与肾动脉正常的患者相比,合并有肾动脉狭窄（RAS）的缺血性脑血管病患者预后不良。我们对缺血性脑血管病与动脉粥样硬化性肾动脉狭窄（ARAS）的相关性及缺血性脑血管病危险因素与肾动脉狭窄的关系进行分析。     

动脉硬化性肾动脉狭窄行经皮肾动脉成形支架植入术后临床疗效分析

目的 探讨经皮肾动脉成形支架植入术在治疗动脉硬化性肾动脉狭窄时对患者血压和肾功能的影响。方法 2010年7月至2013年7月共有48例动脉硬化性肾动脉狭窄患者行肾动脉成形支架植入术,根据其术前肾功能情况将患者分为两组,A组患者（20例）术前估测肾小球滤过率（eGFR）＜60ml/（min·1.73m2）,B组患者（28例）术前eGFR≥60ml/（min·1.73m2）。结果 48例患者共植入了52个支架,随访24个月,患者的收缩压和舒张压较术前明显下降,差异具有统计学意义（P＜0.05）。A组患者的术后eGFR较术前明显升高,差异具有统计学意义（P＜0.05）。结论 肾动脉成形支架植入术对于动脉硬化性肾动脉狭窄患者是一种安全有效的治疗方法,可有效降低患者血压,术前已经出现轻中度肾功能损害的患者术后肾功能得到明显改善。     

比较开搏通与氯沙坦在同位素肾显像中诊断肾动脉狭窄的作用

目的比较开搏通肾显像和氯沙坦肾显像诊断肾动脉狭窄的作用.病例和方法 2000年10月至2001年12月,共46例疑诊肾血管性高血压的住院患者,先行开搏通肾同位素显像,24小时后行氯沙坦同位素肾显像.所有可疑肾动脉狭窄患者在肾显像后7天内行肾动脉造影.结果肾动脉造影显示共92个肾脏中67个肾脏的肾动脉无明显狭窄,另25个肾脏的肾动脉直径狭窄≥50%.开搏通肾显像和氯沙坦肾显像诊断肾动脉狭窄的敏感性分别为60.0%和84.0%,特异性分别为95.5%和97.0%,准确性分别为85.8%和93.4%.后者诊断的敏感性和准确性显著高于前者(P<0.05).结论氯沙坦肾显像诊断肾动脉狭窄的敏感性和准确性明显高于开搏通肾显像.     

99mTc-DTPA肾动态显像在支架置入治疗动脉粥样硬化性肾动脉狭窄中的预测评估价值

目的探讨利用99m Tc-DTPA肾动态显像肾小球滤过率(GFR)指标对成功进行经皮腔内肾动脉支架置入术(PTRAS)治疗的单侧脉粥样硬化性肾动脉狭窄(ARAS)患者的疗效。方法成功进行PTRAS治疗的单侧ARAS患者,在进行PTRAS治疗前2周及术后6个月进行99m TDTPA肾动态显像;根据患者肾动脉造影狭窄程度,狭窄程度50%~69%为轻度组(24例),70%~89%为中度组(25例)及≥90%为重度组(38例);根据GFR测定结果将患者分为三级:GFR≥30 ml/min为1级;15~30 ml/min为2级;GRF15 ml/min为3级;通过比较ARAS患者治疗前后GFR与血压变化情况,分析其对PTRAS疗效的评价作用。结果肾动脉造影结果显示,轻度和中度组GFR显著高于重度组(t=-2.510,P=0.007);术后1级和2级患者的高血压改善率显著高于3级患者(P0.005);Logistics回归分析显示,肾功能分级是影响患者血压改善的唯一影响因素(OR=1.623,P=0.021)。结论 99m Tc-DTPA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,具有重要价值。     

老年高血压肾动脉狭窄患者介入治疗的长期疗效分析

目的评价经皮肾动脉成形术血运重建对肾动脉狭窄老年高血压患者的血压、肾功能等方面中远期的影响及术后支架内再狭窄的相关因素。方法选择合并有高血压的肾动脉狭窄患者199例;经肾动脉成形术重建肾动脉血运。术后平均随访(19±11)个月,观察患者血压、降压药物、肾功能的变化,并对支架内再狭窄进行相关分析。结果 199例患者中,肾动脉成形术成功率97.5%。病变动脉管腔直径狭窄率由(73±11)%降至(12±10)%。术后随访138例患者血压下降明显,收缩压由(161±26)mm Hg(1mm Hg=0.133 kPa)降至(1 37±16)mm Hg,舒张压由(85±1 5)mm Hg降至(77±11)mm Hg,差异有统计学意义(P<0.01);口服降压药物品种明显减少,由平均(2.4±1.2)种降至(1.8±0.9)种(P<0.01);患者手术前后肌酐水平无显著差异,但对术前有肾功能不全患者估测的肾小球滤过率改善差异有统计学意义;术后24个月发生支架内再狭窄14例,非开口病变是再狭窄的危险因素。结论老年高血压肾动脉狭窄患者经皮肾动脉成形术的手术成功率高,并有助于此类患者血压的长期控制,特别是部分肾功能不全患者肾小球率过滤可能会有改善,支架内再狭窄与病变部位相关。     

单侧肾动脉狭窄患者肾静脉肾素活性的变化及意义

目的探讨动脉粥样硬化性肾动脉狭窄患者肾静脉肾素活性变化及其和介入治疗后血压变化的关系。方法测定50例单侧肾动脉明显狭窄(管腔狭窄≥70%)患者肾动脉支架置入前双侧肾静脉和外周静脉肾素活性及血管紧张素Ⅱ浓度,分析其与肾动脉狭窄及支架术后血压变化的关系。结果同时伴有冠状动脉狭窄的患者成功接受冠状动脉及肾动脉血运重建术。狭窄侧肾静脉肾素平均活性明显高于对侧[狭窄侧(1.44±1.73)ng·ml-1·h-1和对照侧(1.27±1.57)ng·ml-1·h-1,P=0.04],14例(28%)狭窄侧与对侧肾素活性比值≥1.5(肾血管性高血压组)。平均随访(12±9)个月,9例术后血压转为正常,其中肾血管性高血压组7例[50%,与对照组2例(6%)比较,P<0.001]。多因素回归分析表明肾素活性比值≥1·5与肾动脉支架术后高血压治愈相关(风险比值OR=3.15,95%CI为1.49~5.97,P=0.02)。结论约三分之一动脉粥样硬化性肾动脉狭窄患者狭窄侧肾静脉肾素分泌显著增加(≥对侧1.5倍),这些患者中半数高血压在肾动脉支架术后可以治愈。     

Long-term follow-up of renal artery stenting in an Australian population

BACKGROUND: Renal artery stenosis comprises both atherosclerotic renovascular disease and fibromuscular dysplasia, and may be associated with refractory hypertension, acute 'flash' pulmonary oedema and renal failure. The long-term clinical effects of renal artery stenting remain unclear. AIM: To assess the procedural and long-term safety and efficacy of renal artery stenting and its effect on blood pressure, antihypertensive medication usage and serum creatinine. METHODS: All patients referred for renal artery stenting at our institution between September 1997 and December 2003 were entered into a prospectively collected database. Systolic and diastolic blood pressure, number of antihypertensive medications, serum creatinine and estimated glomerular filtration rate (eGFR) were recorded. Patients were followed-up at least six months post-procedure. RESULTS: Eighty-nine patients underwent renal arteriography, with 110 stents deployed in 102 lesions. The procedural success rate was 99% with no procedural mortality. There were two cases of peri-procedural haemorrhage and one of sepsis. One patient developed renal and peripheral atheroemboli. FOLLOW-UP: Mean follow-up was 28 months (range 6 months-7 years). Eight patients were lost to follow-up. There were nine deaths with a mean time to death of 20.7 months (range 12 months-3 years). There was a highly statistically significant fall in systolic blood pressure (BP) from 161.7+/-29.5 mmHg pre-procedure to 138.7+/-17.9 mmHg at long-term follow-up post-procedure (p<0.0001). The clinical restenosis rate was 6.2%. Renal function and eGFR remained stable and there was a borderline significant decrease in the number of antihypertensive medications used (p=0.05). CONCLUSION: Renal artery stenting is safe and appears effective for the treatment of clinically significant renal artery stenosis.     

Unilateral stent implantation for renal function in bilateral atherosclerotic renovascular hypertension--a case report

Renal artery stenting improves or preserves renal function in patients with bilateral renovascular disease and chronic renal insufficiency. An 80-year-old male was admitted to the hospital for elevated blood pressure accompanied by congestive heart failure. He had renal insufficiency and severe hypertension secondary to bilateral atherosclerotic renal artery stenosis. Unilateral renal artery stenting in the left kidney resulted in the recovery of renal function, whereas renal artery stenting in the right kidney was technically difficult due to a tortuous aorta. After the left unilateral stent implantation, the serum creatinine concentration decreased from 2.0 to 1.3 mg/dL, and control of his blood pressure required fewer antihypertensive drugs, namely a calcium antagonist, an angiotensin-converting enzyme inhibitor, and diuretics. Fifteen months after stenting, renal scintigraphy demonstrated improved function of the right kidney, despite severe renal artery stenosis, as well as improved function of the left kidney. Renal angioplasty or stenting should be attempted in bilateral atherosclerotic renovascular hypertension with renal insufficiency, even though it may only be successful unilaterally.     

支架置入术治疗肾动脉粥样性肾狭窄的临床疗效

目的评价肾动脉支架治疗肾动脉粥样硬化性狭窄的临床疗效,并用肾图评价1年后患者的分肾功能。方法收集2006年1月至2009年8月在北京协和医院心内科接受一侧或双侧肾动脉支架治疗的106例肾动脉粥样硬化性狭窄患者,采集患者的血压、抗血压药物种类、肌酐、估计肾小球滤过率（eGFR）等临床资料,术后随访6至24个月。结果肾动脉支架术后,患者血压明显降低或稳定,由术前的（160±19）/（86±12）mmHg降至术后6个月的（135±17）/（78±11）mmHg,术后12个月为（138±16）/（77±9）mmHg,术后24个月为（135±14）/（75±10）mmHg。术后6个月的脉压也有明显的下降。所服降压药的种类术前为（2.85±0.73）种,术后6个月为（2.13±0.86）种,术后12个月为（2.19±1.12）种,术后24个月为（2.61±0.87）种。患者肌酐及eGFR无明显变化或轻度降低;而1年后肾图结果显示,部分（11.7%）患者支架侧肾GFR水平稳定或轻度增加,而未支架侧肾GFR水平均有一定程度的降低。结论肾动脉支架重建血运能明显改善肾动脉粥样硬化狭窄患者的血压情况,支架术后单侧的肾功能无明显的改善。     

肾动脉狭窄26例的介入治疗

目的评价经皮肾动脉腔内成形术(PTRA)及支架术治疗肾动脉狭窄的安全性和近期疗效。方法26例经肾动脉造影确诊的肾动脉狭窄患者,造影同时或择期行PTRA和(或)支架术。观察术前、术后血管直径的变化,术中、术后并发症情况,高血压者术前、术后应用降血压药物的种类和剂量以及肾功能变化,并进行3～20个月随访。结果26例肾动脉狭窄均为单侧肾动脉狭窄,病变狭窄程度为70%～99%,平均狭窄程度为(86.4±11.2)%。狭窄病变位于肾动脉开口部18例(69%),非开口部8例(31%)。4例患者存在对侧肾脏萎缩和肾动脉直径细小。26例患者均置入支架,共置入26枚支架,直接支架术15例,同时进行PTRA11例,手术即刻成功率100%。血管内径由术前平均(1.6±0.7)mm(0.7～2.7mm)增至(5.2±1.4)mm(4.0～7.0mm)。术前肾功能不全者2例,术后肾功能均有改善。高血压患者26例,术后血压好转和治愈20例(76.9%)。围术期无并发症及死亡。结论PTRA和(或)支架术是治疗肾动脉狭窄的安全、有效的方法。     

肾动脉支架术在需行冠状动脉旁路术的合并肾动脉狭窄患者的应用

目的为防止冠状动脉旁路术(CABG)术后发生急性肾功能不全,对需行CABG合并肾动脉狭窄患者行肾动脉支架治疗。方法自2001年4月至2005年1月,我院对拟行CABG合并肾动脉狭窄的82例患者的104支狭窄肾动脉行肾动脉支架治疗。82例中合并高血压者77例,肾功能减退者21例。患者在肾动脉支架术前不用抗血小板药物。术后观察患者肾功能的变化。结果104处病变肾动脉支架成功率100%,无并发症。术前肾功能减退者中9例于出院时血肌酐下降,3例支架术后一过性血肌酐升高;术前肾功能正常者中4例支架术后一过性血肌酐升高。所有支架术后一过性血肌酐升高均为双侧肾动脉重度狭窄。结论肾动脉狭窄可能导致CABG术后急性肾功能衰竭的发生。CABG前行肾动脉支架术可能预防术后急性肾功能衰竭的发生。     

EFFECT OF ACUTE INTRAVENOUS ACE-INHIBITION ON THE INTRARENAL DOPPLER FLOW CHARACTERISTICS IN HYPERTENSIVE PATIENTS WITH AND WITHOUT UNILATERAL RENAL ARTERY STENOSIS

Assessment of intrarenal doppler signals is of particular importance in screening for renal artery stenosis. We studied the effect of acute ACE-inhibition (1,25 mg enalaprilate i.v.) on intrarenal resistive indices in 10 hypertensive patients with unilateral renal artery stenosis versus 10 patients with essential hypertension. Any changes limited to poststenotic vessels could possibly improve the diagnostic value of duplex sonography.

After ACE-inhibition a significant fall of the intrarenal Resistive Index occurred in both patient groups. In cases of unilateral renal artery stenosis we saw a tendency to an increased side difference of the Resistive Index due to a greater fall on the poststenotic side.

Therefore a clear advantage of duplex scanning after acute ACE-inhibition due to a limited effect of enalaprilate on poststenotic vessels was not found. The results suggest that the vascular resistance and not only the degree of renal artery stenosis is of significance for the characteristics of the doppler signal.     

肾动脉狭窄支架术后长期疗效相关危险因素分析

目的探讨影响肾动脉狭窄患者支架治疗术疗效的相关因素。方法纳入192例行肾动脉支架置入术治疗的肾动脉狭窄患者,随访血压、血肌酐变化及全因死亡情况,筛选肾功能恶化和死亡的预测指标。结果随访期间患者的血压水平较术前明显下降（P〈0.01）,血肌酐水平升高（P〈0.05）。所纳入病例的全因死亡率为11%。Logistic回归分析显示高龄[比值比（OR）=1.11]和术前肌酐水平偏高（OR=1.007）是全因死亡的预测因素;高龄（OR=2.32）、糖尿病（OR=1.45）、术前肌酐水平偏高（OR=7.1）是肾动脉支架术后肾功能恶化的预测因素。结论肾动脉狭窄支架术治疗动脉粥样硬化性肾动脉狭窄疗效和安全性良好,高龄、术前肌酐水平偏高和合并糖尿病是肾动脉支架术后预后不良的危险因素。     

The significance of elevated troponin T in patients with nondialysis-dependent renal insufficiency: a validation with coronary angiography

BACKGROUND: Patients with elevated troponin are at high risk of adverse outcomes, future cardiac events, and are more likely to have hemodynamically significant coronary artery stenoses. Elevated troponin T (cTnT) in patients with poor renal function portends a poor prognosis; however, findings of significant coronary artery disease (CAD) by coronary angiography have not been demonstrated in patients with poor renal function and elevated cTnT. HYPOTHESIS: The purpose of this study was to correlate the angiographic findings of patients with elevated cTnT with respect to renal function in patients with nondialysis-dependent renal insufficiency. METHODS: We retrospectively identified 342 patients with elevated cTnT who underwent coronary angiography in the setting of acute coronary syndrome. Patients were divided into poor (< 40 ml/min) and normal (> 40 ml/min) renal function by measuring their glomerular filtration rate. Our primary outcome was CAD stenosis, defined as epicardial stenosis > or = 70%. Secondary outcomes were rates of contrast nephropathy, initiation of hemodialysis, revascularization, length of stay (LOS), and in-hospital mortality. RESULTS: There was no significant difference in the prevalence of CAD between patients who had positive cTnT with poor renal function versus patients with positive cTnT and normal renal function (87.1 vs. 89.7%, p = 0.54). This finding persisted after stratifying by age. Patients with impaired renal function had a higher mortality, longer LOS, and a higher rate contrast nephropathy requiring hemodialysis. CONCLUSION: The association between elevated cTnT and significant CAD stenosis does not vary with renal function.