肾滤过分数评价肾动脉支架植入术对动脉硬化性肾动脉狭窄的治疗效果

发布时间：2018-03-29 01:02

本文选题：肾动脉梗阻　切入点：支架　出处：《北京大学学报(医学版)》2017年01期

【摘要】：目的:探讨肾滤过分数(filtration fraction,FF)评价肾动脉支架植入术对动脉硬化性肾动脉狭窄治疗效果的意义。方法:对42例肾动脉狭窄患者,共52条肾动脉行肾动脉支架植入术(percutaneous transluminal renal angioplasty and stent,PTRAS),分析患者健侧肾和患侧肾(分肾)肾小球滤过率(glomerular filtration rate,GFR)、分肾肾有效血浆流量(effective renal plasma flow,ERPF)和分肾肾滤过分数的变化,术前与术后血肌酐(serum creatinine,s Cr)变化,观察患者血压(收缩压)和服用降压药种类的变化。结果:52例肾动脉支架植入手术全部成功,术前患侧GFR明显低于健侧(t=-3.989,P=0.000),ERPF明显低于健侧(t=-4.926,P=0.000)。两侧总体FF值相当(t=1.273,P=0.207),术后患侧肾GFR有所增高,但差异无统计学意义(t=-1.411,P=0.164),术后患侧肾ERPF明显增高(t=-4.954,P=0.000)、FF降低(更趋近于正常值,t=3.274,P=0.002)。术后健侧GFR明显降低(t=2.569,P=0.000),ERPF明显降低(t=3.889,P=0.001),FF无明显变化(t=-0.758,P=0.454)。术后患侧GFR低于健侧(t=-3.283,P=0.002),ERPF低于健侧(t=-3.351,P=0.001),但两侧FF值相当(t=-0.361,P=0.719)。术前FF相对正常的患肾,术后FF值变化较小(t=0.799,P=0.430);术前FF明显升高的患肾,术后FF值较术前降低(趋向正常值,t=5.299,P=0.000)。患者术后总体血肌酐较前明显下降(t=2.505,P=0.016),但对于单侧肾动脉狭窄患者,其血肌酐变化差异无统计学意义(t=1.228,P=0.299);而对于双侧肾动脉狭窄患者,血肌酐较术前明显下降(t=2.518,P=0.030),患者术后血压(收缩压)较术前明显下降(t=8.945,P=0.000),服用降压药物种类较术前明显减少(t=5.280,P=0.000)。结论:对于肾动脉狭窄患者,分肾FF是了解肾缺血病理生理进程的有益指标,术前FF显著增高或FF相对正常,应视为肾动脉支架植入术的手术指征。
[Abstract]:Objective: to evaluate the effect of renal artery stent implantation in the treatment of arteriosclerotic renal artery stenosis by renal filtration fractionation FFF.Methods: 42 patients with renal artery stenosis were enrolled in this study. A total of 52 renal artery stents were implanted with transluminal renal angioplasty and stentstone to analyze the changes of glomerular filtration rate, effective renal plasma flow rate and renal filtration fraction in healthy and affected kidneys. Changes of serum creatinine Cr were observed before and after operation. Blood pressure (SBP) and kinds of antihypertensive drugs were observed. The GFR of the affected side before operation was significantly lower than that of the normal side, the GFR of the affected side was significantly lower than that of the healthy side. The total FF value of the two sides was 1.273 and 0.207, and the GFR of the affected kidney was increased after operation. However, there was no significant difference in the ERPF of the affected side after operation, but there was no significant difference between the two sides. The ERPF of the affected side was significantly higher than that of the normal value (t 3.274g / P = 0.002). The GFR of the healthy side was significantly lower than that of the healthy side (t 2.569P0.000 P0. 001F). The GFR of the affected side was lower than that of the healthy side (t = -3.283P0. 002P 0. 001), but there was no significant change in the level of the GFR of the affected side (t = 0. 758P0. 454a). After operation, the GFR of the affected side was lower than that of the healthy side (t = 3. 283P = 0. 002), but it was lower than that of the healthy side (t = 3. 351a P 0. 001), but the difference between the two sides was not significant. The relative value of FF in the side was 0.361 and 0.7190.The FF was relatively normal in the affected kidneys before operation. After operation, the FF value of patients with significantly increased FF was lower than that of the patients with preoperation (normal value was 5.299m) 0.0000.0.0000.The total serum creatinine of the patients was significantly lower than that of the patients with unilateral renal artery stenosis, but in the patients with unilateral renal artery stenosis, the total serum creatinine level was significantly lower than that of the patients with unilateral renal artery stenosis, but in the patients with unilateral renal artery stenosis, the total serum creatinine of the patients was significantly lower than that of the patients with unilateral renal artery stenosis. There was no significant difference in serum creatinine in patients with bilateral renal artery stenosis. Serum creatinine was significantly lower than that before operation, blood pressure (systolic blood pressure) was significantly lower than that before operation, blood pressure (systolic blood pressure) was significantly lower than that before operation, and the types of antihypertensive drugs were significantly lower than those before operation. Conclusion: for patients with renal artery stenosis, the blood creatinine level was significantly lower than that before operation. Renal FF is a useful index to understand the pathophysiological process of renal ischemia. The FF is significantly increased or FF is relatively normal before operation, which should be regarded as the indication of renal artery stent implantation.
【作者单位】：北京大学第三医院介入血管外科;
【分类号】：R692

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