无创性检查在肾动脉狭窄中的诊断价值

目的探讨无创性检查对肾动脉狭窄的诊断价值。方法回顾性研究临床上怀疑肾血管性高血压(RVH)的患者所进行核素检查、彩色多普勒超声、螺旋CT(CTA)、磁共振血管成像(MRA)与肾动脉造影结果。结果 67例病人中经腹主动脉-肾动脉造影确诊肾动脉狭窄34例,腹主动脉狭窄3例,正常者30例。肾血流图的敏感度约为67.4%,特异度为53.1%;肾动态显像的敏感度约为67.3%,特异度为36.6%;肾脏超声的敏感度约为30%,特异度在91.9%以上;肾动脉彩色多普勒超声的敏感度为58.8%,特异度为83.7%;CTA或MRA的诊断结果与造影相符。结论彩色多普勒超声和核素检查可用于肾动脉狭窄的初步筛查,如果异常,可根据患者的年龄及肾功能状况选择CTA或MRA。肾动脉狭窄程度及下一步治疗方法的选择仍需依靠肾动脉造影。

Clinical application of noninvasive examination in renal arterial stenosis

Objective The purpose of the study was to evaluate the forecasting value of noninvasive examination on the diagnosis to renal arterial stenosis （RAS）. Methods Retrospective study was done based on the results of effective renal plasm flow （ ERDF）, glomerular filtration rate （GFR） , color Doppler ultrasound, spirals computed tomography angiography （ CTA）, magnetic resonance angiography （MRA） and abdomial aorta- renal arterial angiography in suspected renovascular hypertension （RVH）. Results 34 cases were diagnosed RAS,3 case was diagnosed abdomial aorta. 30 cases were diagnosed primary hypertension. In the diagnosis of RAS, the sensitive of ERDF was about 67.4% and the specificity of ERDF was 53.1% ; the sensitive and specificity of GFR was about 67.3% and 36.6% ; the sensitive and specificity of renal Doppler uhrasound was 30% and 91.9% ; the sensitive and specificity of color Doppler ultrasound was 58.8% and 83.7% ; the result of CTA or MRA was coincidence to the result of renal arterial angiography. Conclusion Color Doppler ultrasound and nuclein examination can be used as rudiment screening for RAS, if abnormal, we could choose CTA or MRA on according to the age and renal function of patients. The degree of renal arterial stenosis and which method to choose next were based on renal arterial angiography.