分肾功能测量评估单侧粥样硬化性肾动脉狭窄支架术对肾功能的影响

目的 应用肾动态显像评估单侧动脉硬化性肾动脉狭窄患者腔内治疗效果,并对可能改善分肾功能的影响因素进行分析.方法 回顾性分析北京安贞医院2016年1月-2018年4月收治的60例单侧动脉硬化性肾动脉狭窄患者,均行肾动脉支架成形术.收集患者的一般资料,术前及术后肾功能检查结果,肾动脉彩色多普勒超声(彩超)及肾动态显像结果,...

Evaluation of the effect of endovascular therapy for unilateral atherosclerotic renal artery stenosis by differentiated renal function measurement

Objective To evaluate the efficacy of endovascular therapy in patients with unilateral arteriosclerotic renal artery stenosis using nuclide renal dynamic imaging and to analyze the influencing factors that may improve the renal function.Methods A retrospective analysis was made of 60 patients with unilateral arteriosclerotic renal artery stenosis admitted to Beijing Anzhen Hospital from January 2016 to April 2018.All patients underwent renal artery stent implantation.General clinical data of the patients were collected.Serum creatinine,urea nitrogen,renal artery color doppler ultrasonography and renal dynamic imaging results were obtained before and after operation.The follow-up period was 1 year.According to the results of follow-up renal dynamic imaging after operation,the patients were divided into improved group and non-improved group based on the changes of differentiated glomerular filtration rate of affected side.The regression model was used to analyze the influencing factors.Results All patients were confirmed by renal artery color doppler ultrasonography and arteriography that the stenosis of the affected renal artery was more than 70%.All patients underwent balloon dilatation and stenting of the affected renal artery.The immediate intervention success rate was 100%.The residual stenosis of the affected renal artery was less than 20%.No serious complications occurred during the perioperative period.Systolic blood pressure and diastolic blood pressure were improved after operation(P<0.01).After operation,the differentiated glomerular filtration rate of the affected side showed an improvement trend,there was statistical difference in the repeated measurement analysis of variance(P=0.04).The serum creatinine was basically stable(P=0.25).The degree of renal artery stenosis of the affected side was relieved significantly(P<0.01).One year after operation,the patency rate of renal artery stent was 85%.After grouping,40 patients(66.7%)were divided into the improved group and 20 patients(33.3%)into the non-improved group.The regression model was used to analyze the influencing factors.Only the renal insufficiency of affected side had statistical significance(B=0.50,P<0.01),that is,if the impaired side had renal insufficiency before operation,the differentiated glomerular filtration rate improved after operation.Conclusions Renal artery stenting is safe and effective in the treatment of unilateral renal artery stenosis.One-year patency rate is 85%.Two-thirds of the patients can get improved of their renal function after operation.The patients with preoperative renal insufficiency of affected side are more likely to benefit from renal artery stenting.