肾动脉狭窄的IVUS特点与介入治疗短期疗效的相关性研究

发布时间：2018-07-26 11:51

【摘要】：目的探讨肾动脉狭窄患者粥样硬化斑块IVUS及VH-IVUS特征和介入治疗后短期疗效的相关性。 方法共纳入25名患者（2008年1月1日至2013年11月30日），，通过肾动脉造影、IVUS检查（其中VH-IVUS检查17例）评估肾动脉狭窄病变并进行经皮肾血管成形术治疗，随访术后1周、3月及6月血清肌酐、血压水平，并分别计算eGFR值。 结果在灰阶IVUS检查数据中，仅斑块面积和术前eGFR呈显著相关（r=-0.448，p=0.025），VH-IVUS分析斑块成分和术前基础eGFR无统计学差异。资料显示，随访3月、6月共7例eGFR恶化（32%），15例eGFR较术前改善（68%），术后随访的eGFR值总体水平高于术前水平，术后1周和6月的eGFR水平差异有统计学意义；随访1周、3月和6月的eGFR变化率和IVUS测量的病变节段最小的血管内腔面积呈显著相关（r=0.632，p=0.001；r=0.586，p=0.004；r=0.496，p=0.019）。术后1周的eGFR变化率和VH-IVUS测量的坏死核心及钙化斑块面积呈显著负相关（r=-0.634，p=0.011；r=-0.566，p=0.028），而术后3月和6月的eGFR变化率和VH-IVUS斑块组成无相关关系。同时，随访1周、3月和6月的收缩压平均降幅分别为7.3%、10.7%和13.9%，差异有统计学意义，而IVUS斑块成分和术后血压变化无相关关系。 结论经皮肾动脉血管成形术可改善肾动脉狭窄患者的肾功能和血压水平，IVUS最小管腔面积与术后eGFR变化率呈正相关，提示IVUS斑块分析可能对肾动脉狭窄介入术后短期肾功能变化和血压改变提供更多的信息。
[Abstract]:Objective to investigate the correlation between IVUS and VH-IVUS features of atherosclerotic plaques in patients with renal artery stenosis and the short-term effect after interventional therapy. Methods A total of 25 patients (January 1, 2008 to November 30, 2013) were enrolled in this study. Renal artery stenosis was evaluated by renal arteriography (VH-IVUS in 17 patients) and percutaneous renal angioplasty was performed. Serum creatinine, blood pressure and eGFR were calculated 1 week, 3 months and 6 months after operation. Results in the gray scale IVUS data, there was no significant correlation between plaque area and preoperative eGFR (r-0.448p0. 025) VH-IVUS analysis of plaque composition and preoperative basic eGFR showed no statistical difference. The data showed that 7 cases (32%) of eGFR deteriorated in 6 months (32%) and 15 cases of eGFR were improved (68%) after follow up. The total eGFR level of postoperative follow-up was higher than that of preoperative level, and the difference of eGFR level between 1 week and 6 months after operation was statistically significant. After 1 week of follow-up, there was a significant correlation between the change rate of eGFR in 3 months and 6 months and the area of the smallest vascular lumen measured by IVUS (r = 0.632p0. 001 ~ 0. 586 ~ 0. 004 ~ 0. 496p ~ (0.019). There was a significant negative correlation between the change rate of eGFR and the area of necrotic core and calcified plaque measured by VH-IVUS at 1 week after operation (r = 0.634). However, there was no correlation between the change rate of eGFR and the plaque composition of VH-IVUS in 3 and 6 months after operation. At the same time, the mean systolic blood pressure decreased by 7.3% and 13.9% in 3 months and 6 months, respectively. The difference was statistically significant, but there was no correlation between the plaque composition of IVUS and the blood pressure after operation. Conclusion Percutaneous renal artery angioplasty can improve renal function and blood pressure in patients with renal artery stenosis. The minimum lumen area of IVUS is positively correlated with the change rate of eGFR after operation. The results suggest that IVUS plaque analysis may provide more information on the changes of renal function and blood pressure after renal artery stenosis intervention.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

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