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。     

动脉粥样硬化性肾动脉狭窄和急性冠脉综合征的关系

急性冠脉综合征一直是冠心病领域的热点,在冠脉造影时代越来越多的肾动脉狭窄被确诊。它们在发病机制、发病率、症状特点、诊断方法及预后等方面的关系,值得关注;两病的结局分别为器官功能的衰竭,最终导致心肾综合征,严重影响预后,已成为一个重要的公共卫生课题。本文对急性冠脉综合征和动脉粥样硬化性肾动脉狭窄之间的关系进行综述。     

离体肾动脉瘤切除和自体肾移植术治疗肾动脉瘤

目的:探讨离体肾动脉瘤切除和自体肾移植方法治疗肾动脉瘤的安全性和可行性.方法:肾动脉造影检查确诊右肾动脉瘤1例伴高血压(160/110mmHg).病变位于右肾动脉主干中段处,大小为11 mm×20mm.在低温和肾脏灌注液灌注保护下,肾脏暂时离体,切除动脉瘤并取自体大隐静脉一段行肾动脉重建,然后将肾脏移植到右侧髂窝.结果:手术成功,患者围手术期无严重并发症发生.术后随访6个多月,血压稳定在135/90 mmHg,肾功能正常,移植肾血管彩超示血管吻合良好,血流通畅.结论:该法治疗右肾动脉瘤继发高血压安全可行.     

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.     

频谱多普勒检查对肾动脉狭窄致高血压病的应用价值

目的利用彩超频谱多普勒技术,探讨肾动脉狭窄与高血压病之间的联系。方法对30例患者60个肾的肾动脉狭窄致高血压病病例（A组）,及30例60个肾的正常对照组（B组）,在彩色多普勒血流显像清晰显示主肾动脉血流时采样,测量主肾动脉血流参数,经统计学方法,分析其相关性。结果两组血流参数测值中,肾动脉内径狭窄者与肾动脉内径正常者之间,峰值血流速度（Vmax）有着显著差异。结论对不明原因的高血压病者,可以通过彩超频谱多普勒技术对患者主肾动脉血流参数进行测定,获取客观的、有价值的数据指标,明确肾动脉狭窄的存在与否,指导高血压病患者的临床诊治。     

肾动脉狭窄性高血压食蟹猴模型的建立和评价

目的建立肾动脉狭窄性高血压食蟹猴模型,并制定其评价标准。方法选取7只正常成年雄性食蟹猴,使用丝线及针头狭窄肾动脉,运用两肾一夹(2K1C)法,制作肾动脉狭窄性高血压食蟹猴模型,并对模型进行评价,同时检测血生化相关指标。结果食蟹猴血压变化:术后1周血压开始升高,4周后达到稳定水平,平均血压为(18.70±1.30)/(10.62±0.91)kPa,食蟹猴术后血压显著高于术前(P<0.05),并且可维持至本实验持续时间8周。食蟹猴血生化变化:尿素、肌酐、谷丙转氨酶、谷草转氨酶术后7d明显升高,与术前比较差异有统计学意义(P<0.05);总胆固醇与葡萄糖升高不明显,与术前比较差异无统计学意义(P>0.05)。造模成功率约为71.43%。结论运用2K1C法成功建立肾动脉狭窄性高血压食蟹猴模型,该模型经济、操作简单易行、成功率高、稳定性好。     

Arterial hypertension and neurofibromatosis: renal artery stenosis and coarctation of abdominal aorta.

A 10-year-old girl had arterial hypertension, generalized neurofibromatosis, coarctation of the abdominal aorta and multiple stenoses at the origin of each renal artery. After resection of the stenotic areas and reimplantation of the renal arteries in the aorta, her arterial pressure decreased substantially. However, hypertension recurred and radiologic follow-up 4 1/2 years later showed distinct progression of the coarctation and renewed stenosis of all renal arteries at their origin. The stenotic areas showed eccentric intimal proliferation, frequently bulging into the lumen, with small nodular aggregates of smooth muscle cells and proliferation of fibrous tissue containing spindle-shaped nuclei in a palisading pattern. Hypertension associated with neurofibromatotic vascular disease has been described in 47 other patients in the literature. These patients have been young (mean age, 14 years) and predominantly male. In contrast to fibromuscular dysplasia, in which 95% of all stenoses are found in the distal two thirds of the renal arteries, in vascular neurofibromatosis more than 50% of the stenoses are found at the origin.     

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。     

An 82-year-old woman with worsening hypertension: review of renal artery stenosis

Renal artery stenosis (RAS) is a common disorder in adults with atherosclerosis and is associated with hypertension, impaired renal function, congestive heart failure, and angina pectoris. The incidence of RAS is increasing because of the aging of the US population and increasing prevalence of atherosclerosis. The case of Mrs S, an 82-year-old woman with long-standing hypertension and unilateral RAS detected by magnetic resonance angiography, illustrates the challenges surrounding indications for revascularization. The discussion reviews the clinical presentation and natural history of RAS and strategies for diagnosis. The role of medical therapy, surgery, and endovascular therapy are reviewed, particularly in the context of guidelines and systematic reviews to help clinicians and patients facing this challenging decision.     

Atherosclerotic renal artery stenosis: from diagnosis to treatment

Renovascular hypertension represents a form of correctable hypertension and preventable renal failure. Such patients need to be identified early so that specific therapy can be instigated. Patient identification requires a high index of suspicion in patients with certain clinical features. Subsequent non-invasive imaging may result in angiography which is required for diagnostic purposes and for planning intervention. Correctable therapy takes one of two forms, namely percutaneous transluminal renal angioplasty, with or without stenting, or surgical revascularisation, together with modification of underlying risk factors.     

老年难治性高血压患者动脉粥样硬化性肾动脉狭窄的发病状况及危险因素分析

目的 调查老年难治性高血压患者动脉粥样硬化性肾动脉狭窄(ARAS)的发病状况,并分析其危险因素,为临床早期诊治ARAS提供依据。方法 回顾性分析2016年2月—2021年2月在西安交通大学第一附属医院心内科门诊就诊的老年难治性高血压患者216例的临床资料,根据肾动脉彩超和造影结果分为ARAS组(48例)和非ARAS组(168例)。比较2组临床资料,并分析患者发生ARAS的危险因素。结果 216例患者肾动脉超声提示ARAS共62例(28.70%),经肾动脉造影结果确诊ARAS共48例(22.22%)。ARAS组合并糖尿病、高脂血症、外周血管疾病、冠心病、肾功能不全比例分别为47.92%(23/48)、68.75%(33/48)、39.58%(19/48)、54.17%(26/48)、52.08%(25/48),明显高于非ARAS组[30.36%(51/168)、51.19%(86/168)、18.45%(31/168)、34.52%(58/168)、26.79%(45/168),均P<0.05];多因素logistic回归分析显示,合并外周血管疾病(OR=2.651,95%CI:1...     

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.     

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。     

Phaeochromocytoma with unilateral renal artery stenosis

A patient with renal artery stenosis due to compression by a phaeochromocytoma is described. He underwent nephrectomy and tumour removal successfully.