Bilateral adrenal phaeochromocytomas associated with unilateral renal artery stenosis

A 21 year old male was discovered to be severely hypertensive. He was found to have bilateral adrenal phaeochromocytomas and a single renal artery stenosis. More than 40 cases of coexisting renal artery stenosis and phaeochromocytomas have been reported. The aetiology of renal artery stenosis in association with phaeochromocytoma maybe multifactorial and the radiographic appearances are not always clear-cut. Renin levels in this patient were elevated prior to the removal of the phaeochromocytomas but the renal vein renin ratio did not suggest that the renal artery stenosis contributed significantly to his hypertension. The patient's hypertension resolved following successful removal of the phaeochromocytomas despite persistence of the renal artery stenosis. Thus, though renin levels may be misleading in these cases, renal vein renin ratios may still be helpful in deciding on patient management.     

颈动脉狭窄患者合并肾动脉狭窄的发生率及其危险因素分析

目的:动脉粥样硬化性肾动脉狭窄(Renal artery stenosis, RAS)是全身性动脉粥样硬化(AS)的一部分,在颈动脉狭窄人群中早期发现RAS患者,对改善患者的生活质量及预后均具有重要的临床意义.文中探讨动脉粥样硬化性颈动脉狭窄患者合并肾动脉狭窄(RAS)的发生率及其危险因素. 方法:对入选的126例经脑血管造影证实动脉粥样硬化性颈动脉狭窄的患者同时行非选择性肾动脉造影,分析颈动脉狭窄和RAS及其程度之间的关系,并对临床指标和RAS之间的关系行单变量和多变量Logistic回归分析. 结果:126例动脉粥样硬化性颈动脉狭窄患者中,RAS的发生率为21.4%.Logistic回归分析表明,颈动脉狭窄人群中冠心病和周围血管病对RAS的影响具有统计学意义,其OR值和95%可信区间(95%CI)分别为6.34(2.20~18.26)和3.67(1.29~10.46). 结论:对动脉粥样硬化性颈动脉狭窄的患者,冠心病和周围血管病可能是RAS的预测因素.     

肾动脉狭窄介入治疗的疗效分析

目的评价经皮肾动脉成形术血运重建对于肾动脉狭窄患者的血压、肾功能等方面的影响。方法2004年2月-2008年4月我院收治的肾动脉狭窄患者201例（管腔狭窄≥70％）,经肾动脉成形术重建。肾动脉血运。其中138例患者术后平均随访（13±10）月,观察其血压、降压药物、肾功能的变化。结果201例患者肾动脉成形术成功率96％。病变动脉管腔直径狭窄率由70％±11％降至12％±10％。术后随访138例患者血压下降有统计学意义（P〈0．01）,收缩压由（20．1±3．3）kPa降至（18．3±2．1）kPa,舒张压由（10．9±2．0）kPa降至（10．3±1．5）kPa;口服降压药品种减少（P〈0．01）,由平均（2．4±1．2）种降至（1．8±0．9）种;术后1至23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,支架内再狭窄与肾动脉狭窄病变部位相关。     

单侧椎动脉狭窄患者椎动脉颈段、椎骨段多普勒超声研究

目的 应用多普勒超声观察单侧椎动脉狭窄患者椎动脉第1段颈段(VA1)、第2段椎骨段(VA2)的血流动力学改变.方法 选择单侧椎动脉内径<2.8 mm的狭窄患者30例作为病例组,另选健康自愿者30例作为对照组,分别进行彩色多普勒(CDFI)及频谱多普勒(PW)血流显像检查,观察椎动脉走向,测其内径、峰值流速(Vmax)、阻力指数(RI).结果 对照组中VA1段内径、Vmax、RI均高于VA2段(P<0.05).病例组:狭窄侧中VA1及VA2段的内径、Vmax低于对照组;RI高于对照组.健侧VA1、VA2段内径高于对照组(P<0.01或P<0.05);健侧VA1段Vmax高于对照组(P<0.05),健侧VA2段Vmax与对照组无明显差异(P>0.05);VA1、VA2段RI均高于对照组,但低于同组狭窄侧.狭窄侧和健侧VA1段的内径、Vmax、RI均高于VA2段.结论 多普勒超声检测可以较直观地反映VA1及VA2的狭窄情况,较准确地测量其血流动力学参数,对诊断单侧椎动脉狭窄有实用价值.     

Enalapril in the treatment of hypertension with renal artery stenosis

The converting enzyme inhibitor enalapril, in single daily doses of 10-40 mg, was given to 20 hypertensive patients with renal artery stenosis. The blood pressure fall six hours after the first dose of enalapril was significantly related to the pretreatment plasma concentrations of active renin and angiotensin II and to the concurrent fall in angiotensin II. Blood pressure fell further with continued treatment; the long term fall was not significantly related to pretreatment plasma renin or angiotensin II concentrations. At three months, 24 hours after the last dose of enalapril, blood pressure, plasma angiotensin II, and converting enzyme activity remained low and active renin and angiotensin I high; six hours after dosing, angiotensin II had, however, fallen further. The rise in active renin during long term treatment was proportionally greater than the rise in angiotensin I; this probably reflects the fall in renin substrate that occurs with converting enzyme inhibition. Enalapril alone caused reduction in exchangeable sodium, with distinct increases in serum potassium, creatinine, and urea. Enalapril was well tolerated and controlled hypertension effectively long term; only two of the 20 patients required concomitant diuretic treatment.     

B-TFE肾动脉血管成像在肾动脉狭窄中的应用及图像质量分析

目的与对比增强肾动脉成像（CE—MRA）比较,探讨B-TFE序列肾动脉成像的图像质量及诊断肾动脉狭窄的能力。方法对26侈4怀疑肾动脉狭窄患者的B—TFE序列肾动脉成像和对比增强肾动脉成像资料进行回顾性分析,测量并比较两组两种方法的信噪比（SNR）、对比度噪声比（CNR）、肾动脉的最大显示长度,并对两种方法对肾动脉狭窄程度的分级进行一致性分析。结果B—TFE序列显示了47条肾动脉和9条副肾动脉。CE—MRA显示了51条肾动脉和9条副肾动脉。B—TFE序列的SNR低于CE-MRA,分别为50±13,和69±10（P〈0．03）：B—TFE序列的CNR也低于CE—MRA,分别为46±7和98±11（P〈0．01）。在B-TFE序列两侧肾动脉的最大显示长度均低于CE—MRA的显示长度（右肾动脉：59mm和67mm,P〈0．05;左肾动脉：51mm和56mm,P〈0．05）。CE-MRA显示了10条肾动脉狭窄,B—TFE显示了11条肾动脉狭窄,B-TFE序列与CE-MRA对于狭窄情况的评价具有较好的一致性,K值为0．757（P〈0．01）。结论B-TFE序列图像质量低于CE—MRA,但B-TFE序列能够较准确地评价肾动脉狭窄程度。     

肾滤过分数评价肾动脉支架植入术对动脉硬化性肾动脉狭窄的治疗效果

目的：探讨肾滤过分数（filtration fraction,FF）评价肾动脉支架植入术对动脉硬化性肾动脉狭窄治疗效果的意义。方法： 对42例肾动脉狭窄患者,共52条肾动脉行肾动脉支架植入术（percutaneous transluminal renal angioplasty and stent,PTRAS）, 分析患者健侧肾和患侧肾（分肾）肾小球滤过率（glomerular filtration rate,GFR）、分肾肾有效血浆流量（effective renal plasma flow,ERPF）和分肾肾滤过分数的变化,术前与术后血肌酐（serum creatinine,sCr）变化,观察患者血压（收缩压）和服用降压药种类的变化。结果： 52例肾动脉支架植入手术全部成功,术前患侧GFR明显低于健侧（t=－3.989,P=0.000）,ERPF明显低于健侧（t=－4.926,P=0.000）。两侧总体FF值相当（t=1.273,P=0.207）,术后患侧肾GFR有所增高,但差异无统计学意义（t=－1.411,P=0.164）,术后患侧肾ERPF明显增高（t=－4.954,P=0.000）、FF降低（更趋近于正常值,t=3.274,P=0.002）。术后健侧GFR明显降低（t=2.569,P=0.000）,ERPF明显降低（t=3.889,P=0.001）,FF无明显变化（t=－0.758,P=0.454）。术后患侧GFR低于健侧（t=－3.283,P=0.002）,ERPF低于健侧（t=-3.351,P=0.001）,但两侧FF值相当（t=－0.361,P=0.719）。术前FF相对正常的患肾,术后FF值变化较小（t=0.799,P=0.430）;术前FF明显升高的患肾,术后FF值较术前降低（趋向正常值,t=5.299,P=0.000）。患者术后总体血肌酐较前明显下降（t=2.505,P=0.016）,但对于单侧肾动脉狭窄患者,其血肌酐变化差异无统计学意义（t=1.228,P=0.299）;而对于双侧肾动脉狭窄患者,血肌酐较术前明显下降（t=2.518,P=0.030）,患者术后血压（收缩压）较术前明显下降（t=8.945,P=0.000）,服用降压药物种类较术前明显减少（t=5.280,P=0.000）。结论： 对于肾动脉狭窄患者,分肾FF是了解肾缺血病理生理进程的有益指标,术前FF显著增高或FF相对正常,应视为肾动脉支架植入术的手术指征。     

Captopril-induced acute renal artery thrombosis and persistent anuria in a patient with documented pre-existing renal artery stenosis and renal failure

We describe an elderly man, with pre-existing renal failure and atheromatous renal artery stenosis, who developed persistent anuria due to renal artery thrombosis after acute hypotension following captopril administration. Caution should be used when captopril is first administered to patients with impaired renal function in whom renal artery stenosis is known or suspected.     

动脉硬化性肾动脉狭窄临床危险因素分析

目的:分析动脉硬化性肾动脉狭窄(ARAS)的相关危险因素及与肾功能的相关性.方法:通过选择性肾动脉造影选取ARAS患者38例,分析其临床资料,并选取30例肾动脉正常者作为对照,进行多因素Logistic回归分析.结果:ARAS组与对照组相比较,冠心病、冠状动脉多支病变、糖尿病、肾功能不全患者的患病率增高(P<0.05).年龄、收缩压、肌酐、尿素氮水平明显升高(P<0.05).结论:老年、冠心病、冠状动脉多支病变、高收缩压、糖尿病为ARAS患者的危险因素,严重的ARAS可导致肾功能不全.     

彩色多普勒超声检测椎动脉型颈椎病单侧狭窄

目的:观察椎动脉型颈椎病单侧狭窄时狭窄侧和健侧的高频彩色多普勒声像表现和血流动力学变化.方法:应用彩色多普勒超声诊断仪检测78例椎动脉型颈椎病患者单侧内径≤2.5 mm的椎动脉,观察其形态结构、内径(D)、平均血流速度(TAMX)、阻力指数(RI)和血流量(Q),并与健侧及100例正常组进行对照分析.结果:狭窄侧、健侧和正常组三者之间D、RI、Q均有极显著性差异(P＜0.01);狭窄侧和健侧的TAMX有极显著性差异(P＜0.01);两者分别和正常组对照TAMX均无统计学差异(P＞0.05).结论:高频彩色多普勒超声对临床评价椎动脉型颈椎病单侧狭窄及健侧血流动力学变化及代偿情况提供了有价值的依据.     

肾动脉狭窄的超声造影表现

目的:研究肾动脉狭窄时肾实质超声造影表现.方法:通过手术结扎兔左肾动脉,建立不同程度肾动脉狭窄动物模型,以计算机断层血管成像(Computedtomographic angiography,CTA)检查结果将实验兔分为4组,Ⅰ组:肾动脉狭窄＜50%,Ⅱ组:肾动脉狭窄50%～69%,Ⅲ组:肾动脉狭窄70%-99%,Ⅳ组:...     

肾血管性高血压的介入治疗

目的:评估肾动脉狭窄所致高血压介入治疗的临床疗效。方法:16例高血压患者(男10,女6),年龄36~65(51±9)岁,经肾动脉彩色多普勒超声和肾动脉造影检查证实,均患有严重的肾动脉狭窄,在球囊预扩张的基础上,置入球囊扩张支架,术后定期门诊随访血压和肾功。结果:所有高血压患者术后血压均有明显下降,收缩压从(22.4±1.7)kPa降至(16.7±1.6)kPa;舒张压从(14.3±1.1)kPa降至(10.1±0.9)kPa。6例患者停用降压药物后血压仍维持在正常范围内,其余10名患者降压药从4~5种减至2种后血压仍能满意控制。随访8~12月,疗效能稳定维持。12例患者血肌酐水平稳定无明显变化,4例患者血肌酐水平降低,肾功能得到一定的改善。结论:支架置入是治疗肾血管性高血压的安全有效方法,其初步疗效满意。     

Percutaneous transluminal dilatation of transplant renal artery stenosis

Percutaneous transluminal angioplasty has been applied to the treatment of transplant renal artery stenosis in 3 patients, 2 with severe hypertension resistant to medical therapy, and one with graft dysfunction related to the presence of the stenosis in the early post-transplant period. The clinical courses of the patients before and after angioplasty are illustrated and the usefulness of the technique in this difficult situation stressed.     

Hypertensive encephalopathy complicating transplant renal artery stenosis.

A 26-year-old female diabetic patient developed hypertensive encephalopathy with gross neurological abnormalities complicating renal artery stenosis of her transplant kidney. The elevated blood pressure was unresponsive to medical treatment. Surgical correction of the stenoses in the renal artery cured the hypertension and renal failure and led to the patient''s complete recovery.     

动脉粥样硬化性肾动脉狭窄的治疗学进展

 动脉粥样硬化性肾动脉狭窄(atherosclerotic renal artery stenosis,ARAS)多见于老年人,常伴发糖尿病、血脂异常、冠状动脉疾病和外周血管疾病,可引起肾血管性高血压和/或缺血性肾病。目前很多大型临床试验显示介入治疗与药物治疗相比并无显著的优势,如何合理选择治疗方案以及哪些患者能从介入治疗中获益仍然是临床争议的热点,本文就近年来ARAS的治疗学进展进行综述。