糖尿病患者肾动脉狭窄支架植入术的疗效评价

目的评价糖尿病患者肾动脉狭窄支架植入术后肾功能和血压的变化。方法26例糖尿病肾动脉狭窄患者经皮肾动脉内支架成形并支架植入术，共置入支架28枚（Palmaz支架21枚，Wallstent支架7枚），随访6～24月，观察血压、血肌酐、β2微球蛋白水平及抗高血压药物用药情况，并与术前比较。结果经皮肾动脉成形及支架置入术（PTRAS）成功率96．5％，未发现严重并发症，与术前基线值比较，在术后1-12个月随访血压及血肌酐显著下降（P〈0．05），并且服药种数显著减少（P〈0．05），但12～24个月时血压及血肌酐缓慢回升，接近手术前基线值，与术前基线值比较，差异无统计学意义（P〉0．05）。结论PTRAS术可在短期内改善糖尿病动脉粥样硬化性肾动脉狭窄（ARAS）患者血压及肾功能，但作用有限，糖尿病合并肾动脉狭窄患者行PTRAS要慎重。

Renal Artery Stenosis and Stent Treatment in Diabetic Patients

Objective To assess the outcomes after pecutaneous renal artery stent implantation in diabetic patients with renal artery stenosis. Methods 26 patients with diabetes mellitus （DM） and severe uni-or bi-lateral renal artery stenosis （luminal diameter narrowing ≥ 70% ）were implanted with stents by guiding catheter, 28 stentts were implanted （Palmaz stentt in 21 Wallstent in 6）. Follow up was undertaken for 6 months to 24 moths together with recording the blood pressure,Serum Creatinine, 132 micro-globins and effective number of antihypertensive medication as well and comparing them with those before the procedure. Results Technical success rate was 96.5% （28/29） without serious complication. During 6 -12 months of follow-up, both blood pressure and serum creatinine, significantly decreased（ P 〈 0.05 ）, and less antihypertensive medication was taken（P 〈 0.05 ）. But the blood pressure and serum creatinine resumed gradually to the pre-operational level during 12- 24 months （P 〉 0.05 ）. Conclusion PTRAS could decrease blood pressure and se- rum creatinine level in diabetic patients with ARAS in the short term after operation and its effect was limited, PTRAS should be performed prudently in these patients.