【摘要】 目的 评价彩色多普勒超声对肾动脉狭窄（ARAS）的诊断指标及准确性。 方法 1999年10月-2008年12月对患有高血压病的58例共113根肾动脉进行彩色多普勒超声检查。每例患者均测量肾动脉峰值流速（PSV）与肾内段动脉的阻力指数及肾脏长轴。在双盲条件下，以患者肾动脉造影、MRI血管造影及CT血管造影为标准，评价彩色多普勒超声诊断ARAS的诊断指标及准确性。 结果 彩色多普勒超声诊断肾动脉狭窄的敏感性为60%，特异性为83%，阳性预测值为83%，阴性预测值为61%。患侧肾长轴小于健侧肾长轴，患侧肾峰值流速高于健侧肾峰值流速，患侧肾阻力指数低于健侧肾阻力指数。 结论 肾动脉彩色多普勒超声对于肾动脉狭窄初筛诊断以及评价肾动脉狭窄介入治疗后的近、远期疗效，是一种简便可靠的无创检查手段。【Abstract】 Objective To evaluate the accuracy and index of color Doppler ultrasonography (CDU) diagnosing renal artery stenosis (RAS).〖WTHZ〗Methods〖WTBZ〗A total of 113 renal arteries of 58 patients with hypertension from October 1999 to December 2008 were examined by CDU. The peak systolic velocity (PSV) of the renal artery, resistant index of interior artery of kidney,and long axis of kidney of each patient were obtained. Under the double-blind condition, accuracy and diagnostic index of CDU for diagnosing RAS were evaluated according to the standard of renal arteriography, magnetic resonance angiography or computerized tomography angiography. Results The sensitivity of CDU for diagnosing RAS was 60%, specificity was 83%, positive predictive value was 83%, and negative predictive value was 61%. Long axis of kidney in patients with RAS was shorter than that in the healthy ones. The PSV in patients with RAS was higher than that in the healthy ones, and the resistant index of section artery of kidney in patients with RAS was lower than that in the healthy ones. Conclusion CDU is an easy and reliable non-invasive examination for early diagnosis and screening of RAS and for evaluating a short-or long-term therapeutic effect.
自1934年Goldblatt 发现肾动脉狭窄与高血压的关系以及1978年Gruntzig首次报道1例经皮腔内肾血管成形术（percutaneous transluminal renal angioplasty, PTRA）以来，肾动脉狭窄可导致肾血管性高血压和缺血性肾病已形成共识。目前，肾动脉狭窄的治疗方式包括药物治疗、手术治疗及腔内治疗，合理治疗仍存在争议。但不可否认，腔内治疗是目前多数医疗机构普遍采用的治疗方法。......
Objective To investigate the effectiveness of percutaneous transluminal renal artery stenting (PTRAS) in treating atherosclerotic renal artery stenosis (ARAS). Methods A total of 69 patients with severe ARAS were treated with PTRAS between January 2002 and December 2008. There were 47 males and 22 females with an average age of 66.2 years(range, 42-88 years), including 66 cases of unilateral ARAS (single functional kidney, 1 case) and 3 cases of bilateral ARAS. Renal angiography revealed that the degree of renal artery stenosis was 70%-99%. Concomitant diseases included hypertension (67 cases), atherosclerosis obl iterans (69 cases), coronary heart disease (34 cases), diabetes (44 cases), and hyperl ipidemia (36 cases). Blood pressure, serum creatinine (sCr), and patency of the renal artery were measured to assess the effectiveness of PTRAS after 12 months. Results The renal artery stent was successfully implanted in 68 patients and the technical success rate was 98.6%. One patient was converted to il io-renal bypass because of intra-operative acute renal artery occlusion. One patient died of heart failure at 6 months after PTRAS, and 1 patient was lost at 3 months after PTRAS. The other 66 patients were followed up 32 months on average (range, 13-60 months). The blood pressure decreased significantly at 1 month and gained a further decrease at 12 months after PTRAS when compared with the preoperative ones [systol ic blood pressure: (132 ± 24) mm Hg vs (163 ± 34) mm Hg, P lt; 0.05; diastol ic blood pressure: (78 ± 11) mm Hg vs (89 ± 17) mm Hg, P lt; 0.05; 1 mm Hg=0.133 kPa]. Hypertension was cured in 4 cases (6.3%), improved in 52 cases (81.2%), failure in 8 cases (12.5%), and the overall benefit rate was87.5%. The sCr level was stable after 12 months of PTRAS, showing no significant difference when compared with preoperative basel ine [(107.8 ± 35.4) μmol/L vs (104.1 ± 33.8) μmol/L, P gt; 0.05]. Renal function was improved in 9 cases (13.6%), stable in 48 cases (72.8%), deterioration in 9 cases (13.6%), and the overall benefit rate was 86.4%. Instent restenosis found in 2 patients (3.0%) at 12 months after operation. Conclusion PTRAS is a safe and effective method to treat ARAS. It can control the blood pressure and stabil ize the renal function in most ARAS patients. Long-term efficacy needs further investigation.
ObjectiveTo study the clinical safety and effectiveness of paclitaxel-drug coated balloon (DCB) in treatment of Takayasu’s arteritis (TA) of renal artery. MethodsThe retrospective analysis was made on the clinical data of the three patients with severe stenosis of renal artery, who were treated in our hospital from January 2019 to August 2023. The patients underwent paclitaxel-DCB dilation therapy. ResultsSuccessful treatment was accomplished in all the three patients. The patients were followed up for 17, 38, and 40 months respectively, follow-up examination of ultrasound showed that the blood flow in renal artery was unobstructed. The serum creatinine level was changed from preoperative 53, 64, 55 μmol/L to 43, 70, 59 μmol/L on postoperative day 1. The systolic blood pressure was decreased from preoperative 180, 220, 150 mmHg to 116, 120, 110 mmHg on postoperative day 1. The peak systolic velocity of renal artery was reduced from preoperative 350, 377, 293 cm/s to 120, 135, 94 cm/s on postoperative day 1. ConclusionPaclitaxel-DCB is safe and effective for patients with renal artery stenosis of TA, but further researches with large sample are still needed.