肾静脉肾素对肾动脉介入患者血压的评估价值

发布时间：2018-03-19 01:25

本文选题：肾动脉狭窄　切入点：肾静脉肾素测定　出处：《上海交通大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨肾静脉血浆肾素活性（PRA）测定对肾动脉狭窄（RAS）患者介入治疗后血压变化情况的预测评估价值。方法：选取57例2002年至2013年在上海瑞金医院高血压科住院的患者，高度怀疑肾动脉狭窄（RAS），测定双侧肾静脉及下腔静脉血浆肾素活性（PRA），并行肾动脉造影（RA）明确诊断。根据患者具体情况综合评估决定是否行介入手术治疗。记录患者术前及术后随访的24小时动态血压。将患者分为造影阴性组，双侧肾动脉狭窄组和单侧肾动脉狭窄组，比较左右两侧肾静脉PRA的区别。计算由PRA测定推导出来的指标，Vich表示缺血侧肾素，Vctl表示对侧肾素，Viivc表示下腔静脉肾素：Visch/Vctl RVRR：狭窄侧肾静脉PRA/正常侧肾静脉PRA、(Visch-Viivc)/Viivc：狭窄侧肾静脉PRA减下腔静脉PRA除以下腔静脉PRA、(Vctl-Viivc)/Viivc：正常侧肾静脉PRA减下腔静脉PRA除以下腔静脉PRA、Vctl/Viivc：正常侧肾静脉PRA除以下腔静脉PRA。根据随访肾动脉介入治疗（经皮腔内肾血管成形及支架植入术）后患者血压变化情况，，将患者分为无效、改善和痊愈组，统计分析上述由肾静脉PRA推导出的指标对评估患者术后血压变化的价值，探讨以上指标是否能够区分哪些患者可以从介入手术中获益。结果：共57例患者，3例因拒绝行肾动脉造影予排除。20例患者肾动脉造影阴性作为对照组，34例为肾动脉狭窄（RAS），27例为单侧肾动脉狭窄（Uni-RAS），7例为双侧肾动脉狭窄（Bi-RAS），病因诊断为粥样硬化性肾动脉狭窄（ARAS）患者29例，肾动脉肌纤维发育不良（FMD）5例。其中26例患者行介入术，5例行单纯球囊扩张术，21例行支架植入术。首先我们研究了在单侧肾动脉狭窄患者中，狭窄侧与非狭窄侧肾静脉肾素值比较P0.05，无明显统计学差异。对介入治疗后随访的RAS患者进行分析发现，从肾静脉PRA测定推导出来的指标都不能很好的区分哪些患者可以从介入手术中获益。在单侧肾动脉狭窄组RVRR＞1.5也不能有效的评估患者介入术后血压情况。结论：总的来说，肾静脉血浆肾素活性测定对判断肾动脉狭窄患者是否需要行介入术基本无意义，我们急需寻求更加可靠实用有效的指标。
[Abstract]:Objective: to evaluate the predictive value of plasma renin activity (PRA) in patients with renal artery stenosis (Ras) after interventional therapy. Methods: 57 patients were selected from 2002 to 2013 in the Department of Hypertension, Ruijin Hospital, Shanghai. RASA was highly suspected of renal artery stenosis. The plasma renin activity of bilateral renal veins and inferior vena cava was measured. Renal arteriography was performed to make a definite diagnosis. According to the specific conditions of the patients, a comprehensive evaluation was made to determine whether or not to perform interventional surgery. The patients were recorded. 24 hours ambulatory blood pressure was followed up before and after operation. The patients were divided into two groups: negative group. Bilateral renal artery stenosis group and unilateral renal artery stenosis group, Compare the differences of PRA between left and right renal veins. Calculate the index derived from PRA measurement: Vctl indicates ischemic renin / Vctl means contralateral renin / Vctl RVRRR: narrow side renal vein PRA/ normal side renal vein PRA Visch-Viivc / Viivc: narrow side renin / Vctl RVRR: narrow side of renal vein PRA/ normal side of renal vein (PRA) Visch-Viivc / Viivc / Viivc: contralateral side. Renal vein PRA subtractive inferior vena cava PRA Vctl-Viivcn / Viivc: normal renal vein PRA subtractive inferior vena cava PRA: normal renal vein PRA except vena cava PRA. The changes of blood pressure in patients after orthoplasty and stent implantation, The patients were divided into three groups: ineffective group, improved group and cured group. The above indexes derived from renal vein PRA were statistically analyzed to evaluate the changes of blood pressure after operation, and to explore whether the above indexes could distinguish which patients could benefit from interventional surgery. Results: a total of 57 patients with renal arteriography were excluded from renal arteriography. 20 patients were negative for renal arteriography as control group. 34 patients with renal artery stenosis and 27 patients with unilateral renal artery stenosis. 7 patients with bilateral renal artery stenosis. 29 patients were diagnosed as atherosclerotic renal artery stenosis. There were 5 cases of renal artery muscular fiber dysplasia. Among them, 26 cases were treated by interventional surgery and 5 cases by balloon dilatation and 21 cases by stenting. First, we studied the patients with unilateral renal artery stenosis. There was no significant difference in renin level between the stenosis side and the non-stenosis side (P 0.05). The indexes derived from renal vein PRA could not distinguish which patients could benefit from interventional operation. RVRR > 1.5 in unilateral renal artery stenosis group could not effectively evaluate the blood pressure after interventional operation. Conclusion: in general, the determination of renin activity in renal vein plasma is of no significance in judging whether or not renal artery stenosis patients need interventional procedures. We urgently need to seek more reliable and effective indicators.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692;R544.1

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