经皮肾动脉支架术治疗肾血管性高血压的临床结果

目的:评估支架重建血运治疗肾血管性高血压的安全性与近中期临床疗效。方法:1999年至2004年,我院连续203例肾动脉严重狭窄的患者,其中男性128例(63．1％),女性75例(36．9％), 年龄13-82(54±18)岁,病因分别为动脉粥样硬化123例(60．6％)、大动脉炎62例(30．5％)和纤维肌性结构不良18 例(8．9％),因严重高血压或伴有肾功能不全而进行了肾动脉支架置放术(PTRAS),并随诊6个月,观察手术对患者血压、肾功能的影响。结果:203例患者中,PTRAS成功200例(98．5％)。术后6个月随访时与术前比较血压明显下降,服药种数明显减少(P<0．001)。其中68例(33．5％)治愈,108例(53．2％)改善,27例(13．3％)无效。血肌酐总体上无统计学意义的变化(P>0．05),但肾功能异常的35例患者血肌酐明显下降(P<0．05)。PTRAS的手术并发症共14例(6．9％)。6个月随诊期间无死亡。结论:支架重建血运治疗肾动脉狭窄有较好的安全性和近中期疗效。     

经皮肾动脉支架术治疗肾血管性高血压的临床结果

该文评估支架重建血运治疗肾血管性高血压的安全性与近中期临床疗效。方法：1999-2004年，我院连续203例肾动脉严重狭窄的患者，其中男性128例（63．1％），女性75例（36．9％），年龄13～82（54&#177;18）岁，病因分别为动脉粥样硬化123例（60．6％）、大动脉炎62例（30．5％）和纤维肌性结构不良18例（8．9％）。因严重高血压或伴有肾功能不全而进行了肾动脉支架置放术（PTRAS），并随诊6个月，观察手术对患者血压、肾动能的影响。结果：203例患者中，PTRAS成功200例（98．5％）。     

支架置入术治疗粥样硬化性肾动脉狭窄对肾功能疗效的观察

目的　探讨经皮肾动脉内支架置入术 (percutaneoustranslumminalrenalangioplastywithstent,PTRAS)治疗动脉粥样硬化性肾动脉狭窄 (atheroscleroticrenalarterystenosis,ARAS)对肾功能的影响。方法　经肾动脉造影确诊的ARAS并施行PTRAS的患者 17例 ,术后随访 3～ 4 8(16 .3± 14 .8)个月 ,回顾性分析术后患者血清肌酐、血压水平和再狭窄的发生率。结果　 17例PTRAS全部成功 ,术后肾功能改善 4例 (2 3.5 3% ) ,肾功能稳定 9例 (5 2 .93% ) ,总有效率达到 76 .4 7% (13 17例 ) ;肾功能恶化 4例 (2 3.5 3% )。随访长达 2 4～ 4 8个月的 7例患者有 6例肾功能稳定。血压下降或药物控制使血压 <14 0 90mmHg(1mmHg=0 .133kPa) 15例 (88.2 4 % ) ,发生再狭窄 4例 (2 3.5 3% )。结论　PTRAS治疗ARAS能够使肾功能改善或稳定 ,部分患者肾功能长期稳定。     

肾动脉支架置入术治疗老年粥样硬化性肾动脉狭窄的研究

目的 回顾性研究老年动脉粥样硬化性肾动脉狭窄(ARAS)患者行经皮腔内肾动脉支架置入术(PTRAS)的临床疗效.方法 选择2003年1月至2006年3月在解放军总医院经肾动脉造影确诊为ARAS、肾动脉面积狭窄≥70%、年龄≥65岁病例,分为治疗组(35例,行PTRAS术治疗)和对照组(8例,给予药物治疗).统计分析两组血压、肾功能的变化趋势和PTRAS术后支架内再狭窄发生率.结果 治疗组行PTRAS术后3天血压明显下降[术前(155.4±24.8)/(79.4±10.8) mm Hg比术后(126.8±10.9)/(67.3±8.9) mm Hg;P＜0.01),术后12个月血压[(134.6±15.5)/(68.6±7.4)mm Hg]仍明显低于术前(P＜0.01),至术后24个月时血压回升,逐渐接近术前水平.治疗组口服降压药物的种类术后明显减少(术前2.6±1.0 种比术后6个月 1.9±0.9种;P＜0.01),但术后12个月以后用药种类开始增加,接近术前水平.对照组在肾动脉造影术后12个月内血压水平及口服降压药物种类均较造影前无显著变化.治疗组术后12个月时68.8%的患者肾功能无变化,15.6%的患者肾功能可改善,但是术后肾功能恶化的比例逐渐增加,至24个月时达到35.7%.对照组肾动脉造影术后12个月内肾功能全部为不变化.Logistic多元回归分析显示,PTRAS术后12个月时发生肾功能恶化与患者术前合并3期以上慢性肾脏病有关(P=0.005,OR=46.5),与术后采用水化治疗有关(P=0.019,OR=0.24).治疗组PTRAS术后支架内再狭窄率为20%.多元回归分析示PTRAS术后发生支架内再狭窄与患者术前合并糖尿病有关(P=0.027,OR=47.82).结论 PTRAS术可在24个月内明显降低老年ARAS患者的血压.但是PTRAS术改善老年ARAS患者肾功能的作用有限,且存在肾功能恶化的风险.     

支架重建血运治疗肾动脉狭窄初步结果

目的 评估支架重建血运治疗肾动脉狭窄的安全性与近期疗效。方法 30例肾动脉狭窄的患者因严重高血压或伴有肾功能不全而进行了肾动脉支架置放术（PTRAS）,并随诊3个月,观察手术对患者血压、肾功能的影响。结果 30例患者中,PTRAS成功29例（96．7％）;至3个月随诊时,患者血压明显下降（P＜0．001）,收缩压从173．5mmHg(1mmHg=0.133kPa)降至135.8mmHg,舒张压从95．8mmHg降至75．6mmHg,患者服用降压药物种类明显减少（从平均2．5种减至1．5种,P＜0．001）;其中5例（16．7％）治愈,22例（73．3％）改善,3例（10％）无效;血肌酐2例（6．7％）轻度下降,28例（93．3％）无变化。结论 支架重建血运治疗肾动脉狭窄有较好的安全性和近期疗效。     

老年人动脉粥样硬化性肾动脉狭窄支架置入术治疗的疗效

目的评价老年人动脉粥样硬化性肾动脉狭窄(ARAS)行经皮腔内肾动脉支架置入术(PTRAS)的临床疗效。方法收集我院近3年行PTRAS术老年患者(年龄≥65岁)28例,分析手术前后血压、肾功能的变化。结果术后第3天,28例患者血压明显降低,术前为(160±24)／(80±11)mm Hg,术后(128±12)／(67±9)mm Hg(P<0．01),术后12个月血压水平仍明显低于术前(P< 0．01)。术后口服降压药物的种类也明显减少,分别为(2．7±1．0)种和(1．9±0．9)种,但术后12个月以后用药种类开始逐渐增加。术后12个月时,患者肾功能无明显变化;术后24个月时,随访11例,4例(36．4％)患者出现肾功能减退;术后肾动脉再狭窄率为25．0％。Logistic多元回归分析显示,术后出现肾功能恶化与术前合并3期以上慢性肾脏病有关(P<0．05,OR=5．97);术后发生再狭窄与合并糖尿病有关(P<0．05,OR=36．4)。结论PTRAS术可在24个月内明显降低老年ARAS患者的血压,可在12个月内维持患者肾功能的稳定,老年PTRAS患者术后肾动脉再狭窄率较高。     

肾动脉支架植入术治疗肾动脉狭窄疗效及安全性评价

60例经肾动脉造影提示肾动脉主干狭窄≥50％诊断为肾动脉狭窄（RAS）的患者,随机分为两组,其中治疗组采用内科保守治疗联合肾动脉支架植入术（PTRAS）治疗,对照组采用内科保守治疗。治疗组30例患者手术共置入35枚支架,手术成功率100％。随访结果治疗组肾功能指标、患者血压、降压药服用情况与术前比较均有显著差异,术后未见明显并发症;临床疗效治疗组明显优于对照组。提示PTRAS是一种安全、有效的治疗RAS的方法。     

老年动脉粥样硬化性肾动脉狭窄患者支架置入术后肾功能的变化

目的探讨经皮腔内肾动脉支架置入术(PTRAS)治疗动脉粥样硬化性肾动脉狭窄(ARAS)对肾功能的影响。方法经肾动脉造影确诊的ARAS并施行PTRAS患者50例,术后随访3～48(16.3±14.8)个月,回顾性分析PTRAS后患者血清肌酐和再狭窄发生率。结果 50例PTRAS全部成功。与PTRAS前比较,20例(40%)症状改善和26例(52%)症状稳定患者血清肌酐水平明显下降[(151.47±54.86)μmol/L vs(182.50±68.87)μmol/L,P<0.01;(95.56±1 2.87)μmol/L vs(101.37±1 5.53)μmol/L,P<0.05],4例(8%)症状恶化患者血清肌酐水平明显升高(P<0.05)。随访期间再狭窄6例(12%)。结论 PTRAS能够改善老年人肾动脉粥样硬化所致肾功能改变,并使肾功能长期保持稳定。加强对军队老干部PTRAS后的健康教育,可部分提高患者对相关危险因素的控制,减少术后并发症的发生,提高生活质量。     

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。     

缺血性慢性肾功能不全支架置入后肾功能的长期预后

目的探讨缺血性慢性肾功能衰竭患者经皮肾动脉内支架置入(PTRAS)后肾功能的长期预后。方法肾动脉狭窄≥70%伴慢性肾衰15例患者(双侧肾动脉严重狭窄14例,孤立肾肾动脉严重狭窄1例),年龄78·9±2·9岁(70~85岁),PTRAS后随访(14·4±7·1)个月(6~38个月)。回顾性分析PTRAS前、后肾功能及临床相关资料。结果(1)PTRAS时血清肌酐(SCr)(196·59±86·27)μmol/L(128·6~389·1μmol/L),近1年血清肌酐倒数(1/SCr)(-0·00276±0·00180)L·μmol-1·mo-1;PTRAS后(14·4±7·1)个月时SCr(179·19±81·91)μmol/L(102·4~367·1μmol/L,与PTRAS前比较P<0·05),1/SCr(+0·00724±0·00134)L·μmol-1·mo-1(与PTRAS前比较P<0·05)。(2)逐步回归分析显示,治疗后肾功能改善与PTRAS前肾功能减退速率呈负相关(P<0·05),而与年龄、高肾阻力指数、PTRAS时SCr水平、血压水平、有否糖尿病等无关(P>0·05)。(3)随访结束时无进入透析或死亡病例。2例患者PTRAS前伴心脏紊乱综合征(分别为双侧肾动脉严重狭窄伴不稳定性心绞痛1例,慢性心功能衰竭1例)稳定。结论PTRAS能够使缺血性慢性肾功能衰竭的多数患者肾功能长期稳定。     

肾动脉支架置入治疗动脉粥样硬化性肾动脉狭窄的疗效

目的评价肾动脉内支架置入治疗动脉粥样硬化性肾动脉狭窄的疗效。方法动脉粥样硬化性肾动脉狭窄51例,均成功施行肾动脉内支架置入术,定期门诊随访1年,测定血压、血生化,行计算机断层血管造影及肾动脉造影检查。结果支架置入后,高血压控制满意29%(15/51)、改善59%(30/51)、无效12%(6/51);12个月随访:高血压控制满意36%(18/51)、改善51%(26/51)、无效14%(7/51);复查肾动脉造影20例,未出现支架内再狭窄。术后1周血肌酐由术前(120±50)μmol/L降至(91±22)μmol/L,内生肌酐清除率从(56±16)ml/min升至(72±14)ml/min,外周静脉血肾素从(2.1±0.8)nmol/L降至(1.5±0.6)nmol/L,与术前相比差异均有统计学意义(P<0.05)。结论肾动脉内支架植入术是治疗动脉粥样硬化性肾动脉狭窄安全而有效的方法,对高血压临床疗效肯定,并具有一定的肾功能保护作用。     

Percutaneous vascular interventions in renal artery diseases

Renal artery stenosis (RAS) is a progressive manifestation of atherosclerosis. It is associated with hypertension and progressive renal failure. Noninvasive testing includes renal artery duplex, computed tomographic angiography (CTA) and magnetic resonance angiography (MRA). Percutaneous transluminal renal angioplasty and stenting (PTRAS) is indicated for significant atherosclerotic RAS while percutaneous transluminal renal angioplasty (PTRA) is indicated for fibromuscular dysplasias (FMD) associated with the proper clinical indications. PTRAS is associated with a high technical success rate and an acceptable adverse event and restenosis rate. PTRAS appears to improve control of hypertension and renal preservation. All patients should be followed clinically and with periodic duplex ultrasonography. Restenosis is treated with repeat angioplasty and occasionally stenting. Current and future areas of investigation will involve distal protection and drug eluting stents.     

支架置入重建血运治疗肾动脉狭窄中期临床结果

目的　评估支架置入重建血运治疗肾动脉狭窄的安全性与近中期临床疗效。方法　1999年至 2003年,我院连续 150例肾动脉严重狭窄的患者,其中男性 93例 ( 62. 0% ),女性 57例(48. 0% ),年龄 13~82岁,平均(52±19)岁, 病因分别为动脉粥样硬化 96例(64 0% )、大动脉炎 44例(29. 3% )和纤维肌性结构不良 10例 (6 .7% ),因严重高血压或伴有肾功能不全而进行了支架置入, 随诊 6个月,观察手术对患者血压、肾功能的影响。结果　150例患者中,支架置入成功 148例(98 7% ),病变处管腔直径狭窄从 65% ~100% (85 .5% ± 12. 3% )降至 0 ~25% ( 7 .6% ±5 2% ),管腔最小直径从 0~2 7mm (1 6±0. 9mm)增至 4 5~8 0mm(6 0 ±1 1mm)。6个月随诊时, 患者血压明显下降(P<0 001), 收缩压从(169 .6±32. 5)mmHg(1mmHg=0 133kPa)降至(142 .7±28 .1)mmHg,舒张压从(97 .3±17 .8)mmHg降至 (83 .3±15. 2)mmHg,服用降压药明显减少 (从2 7种减至 1 9种, P<0 001)。其中 48例(32 0% )治愈, 78例(52 0% )改善, 22例(16. 0% )无效。术后血肌酐改善 34例(22. 7% )、无变化 112例 ( 74 .6% )及恶化 4例 ( 2. 7% ),总体上差异无统计学意义。肾动脉支架置入的手术并发症共 12例(8% )。6个月随诊期间无死亡。结论　支架置入重建血运治疗肾     

Renal artery stenosis: optimizing diagnosis and treatment

Renal artery stenosis (RAS) is the most commonly caused by atherosclerosis, with fibromuscular dysplasia being the most frequent among other less common etiologies. A high index of suspicion based on clinical features is essential for diagnosis. Revascularization strategies are currently a topic of discussion and debate. When revascularization is deemed appropriate, atherosclerotic RAS is most often treated with stent placement, whereas patients with fibromuscular dysplasia are usually treated with balloon angioplasty. Ongoing randomized trials should help to better define the optimal management of RAS.     

Recurrence of resistant hypertension after renal artery stent implantation： A case report

Takayasu＇s Arteritis is a chronic non-specific inflammatory vascular disease involving the aorta and its major branches. Takayasu＇s arteritis is one of important reason for renal artery stenosis（RAS） which may result in severe hypertension. Angioplasty, preferably with stenting, is recommended in RAS secondary to atherosclerosis. However, the safety and efficacy of stent implantation is still unclear in RAS caused by Takayasu＇s arteritis. In order to raise the awareness for the importance of Takayasu＇s arteritis in renal artery disease and further to discuss the endovascular revascularization strategies, we are going to present a case report regarding RAS resulted by Takayasu＇s arteritis and provide a timely summary and update on current understanding.     

支架置入术联合自体肾移植术治疗双侧肾动脉狭窄1例并文献复习

目的:评估支架置入术联合自体肾移植术治疗肾血管性高血压的疗效。方法:顽固性高血压患者1例,经血管造影证实为双侧肾动脉显著狭窄,左肾动脉起始部70%~80%狭窄,行肾动脉支架置入术(PTRAS),右肾动脉起始部90%狭窄,因狭窄部紧靠右肾动脉起始部,而且伴有显著的狭窄后扩张,故未行PTRAS,而采用自体肾移植术。结果:经左肾动脉行支架置入术后,血压控制仍不满意,继而行右侧自体肾移植术,术后停服所有降压药物,血压能维持在正常水平。结论:在双侧肾动脉显著狭窄时,采用支架置入术联合自体肾移植术是合理及有效的治疗手段。     

Effects of the correction of renal artery stenosis on blood pressure, renal function and left ventricular morphology

The aim of this study was to evaluate the effect of renal artery stenosis (RAS) correction in hypertensive patients on 24 h SBP, 24 h DBP, creatinine clearance (GFR), urinary albumin excretion (UAE) and LV morphology and mass (LVMI). A total of 61 hypertensive patients with RAS undergoing PTRA and/or surgical treatment entered the prospective study. The final analysis was done in 44 patients (age range 45.8 +/- 16.2 years) with RAS (atherosclerosis (ASC) 31 patients, fibromuscular dysplasia (FMD) 12 patients, arteritis 1 patient) who underwent PTRA (34 patients) or surgical treatment (10 patients) and presented no Doppler signs of restenosis (or a new stenosis) during 1-year observation. The pre-interventional assessment repeated after 6 and 12 months included ABPM, GFR, UAE and echocardiography. The results were analysed in the combined group (CG) and in according aetiology. 24 h SBP and 24 h DBP decreased in all groups 6 months post-intervention and did not change further. Cure of HT was observed in 35% and 29% of ASC patients at 6 and 12 months respectively; and in 58% of FMD patients. Failure rate at 12 months was 48% in ASC against 25% in FMD. The mean GFR in CG was higher 12 months after intervention. The increase in GFR was noted in 45% of patients, the decrease in 25% of patients at 12 months. Normal values of UAE were found in 71% of patients, pre- and post-intervention alike. Mean LVMI and number of patients with LVH in CG decreased already during the initial 6 months post-intervention and did not change further. In conclusion, correction of RAS leads to cure of or improved control of hypertension in the majority of the patients with FMD, but in the ASC group in about half of cases no BP cure or improvement was seen. The renal function was improved or stable in two-thirds of patients after revascularization. Successful renal revascularization was followed by regression of LVH, which was evident within 6 months post-intervention.     

Renal artery stenosis with significant proteinuria may be reversed after nephrectomy or revascularization in patients with the antiphospholipid antibody syndrome: a case series and review of the literature

Renal artery stenosis (RAS) is a disease which might present as hypertension, renal insufficiency or proteinuria and even as nephrotic syndrome. While 90% of cases are secondary to atherosclerosis, the rest of the cases are usually related to fibromuscular dysplasia. Recently, RAS has also been documented in patients with the antiphospholipid syndrome (APS). Although cases of nephrotic syndrome induced by RAS have been published, cases of patients with APS and nephrotic syndrome attributed to RAS were not reported in the literature. In this paper, three young male patients with APS, hypertension and significant proteinuria secondary to RAS are presented. The patients were treated with nephrectomy or revascularization in addition to prior treatment with warfarin, with improvement of the hypertension and the proteinuria. The relationship between renal artery stenosis, nephrotic range proteinuria and APS is reviewed. We suggest that renal artery stenosis should be included in the differential diagnosis of the nephrotic syndrome and that APS should be included in the differential diagnosis of renal artery stenosis especially in young male patients with proteinuria.     

经皮肾动脉成形术对肾动脉狭窄患者血压和肾功能的影响

目的探讨经皮肾动脉成形术对肾动脉狭窄患者血压和肾功能的影响。方法选择经皮肾动脉成形术治疗的23例肾动脉狭窄患者作为研究对象,对其临床资料进行回顾性分析,观察术后血压和肾功能的变化并分析疗效。结果 23例患者均成功植入肾动脉支架,术后残留狭窄均小于30%,手术成功率为100%,术中术后均未发生严重并发症。术后均随访12个月,高血压治愈3例,改善17例,总改善率为86.9%;肾功能改善6例,稳定13例,总获益率为82.6%。收缩压由180.3±35.6 mmHg降为131.2±25.4 mmHg,舒张压由106.2±21.5 mmHg降为80.6±14.2 mmHg,血肌酐由286.4±113.7μmol/L降为166.5±84.8μmol/L,手术前后比较差异有统计学意义(P<0.05)。结论经皮肾动脉成形术和肾动脉支架植入治疗肾动脉狭窄的手术成功率高,有助于控制血压和稳定肾功能,远期疗效需进一步随访观察。