粥样硬化性肾动脉狭窄的诊疗进展
发布时间：2018-08-17 11:52
【摘要】：粥样硬化性肾动脉狭窄(atherosclerotic renal artery stenosis,ARAS)是指动脉粥样硬化导致的肾动脉主干及其分支动脉的狭窄或闭塞性所致的一种疾病。在我国动脉粥样硬化已经成为肾动脉狭窄(renal artery stenosis,RAS)的首要病因,并逐渐超过糖尿病肾病,成为终末期肾病增长最快的原因。ARAS的病理生理机制极为复杂,这也是使得ARAS临床表现多样,临床治疗效果欠佳。目前由于肾动脉彩超、CT血管造影术、磁共振血管成像术的普及使得其诊断方面并不困难,但ARAS在的治疗方面尚无任何公认最佳的治疗药物或者治疗手段。经皮经腔肾动脉成形术(percutaneous renal artery angioplasty,PTRA)及支架植入术(percutaneous renal artery stenting,PTRAS)曾经作为ARAS的首选治疗方法。但近年来几个大型随机临床研究得出肾动脉支架血运重建与药物治疗对预后的影响无显著差别的结论,而这些研究及结论引起众多学者的广泛争议。这使得ARAS患者具体治疗方案的选择成为困扰临床医生的实际问题。近年来新的国内外研究显示保证介入治疗疗效的关键在于术前预测指标的选择和适应症的把握。本文就ARAS病理生理机制、介入治疗的争议、诊断与术前预测指标、治疗的研究进展进行综述。
[Abstract]:Atherosclerotic renal artery stenosis (ARAS) is a disease caused by stenosis or occlusion of renal artery trunk and its branches caused by atherosclerosis. In China, atherosclerosis has become the primary cause of renal artery stenosis (RAS) and gradually exceeds glucose. Urinary nephropathy is the fastest growing cause of end-stage renal disease. The pathophysiological mechanism of ARAS is extremely complex, which makes the clinical manifestations of ARAS diverse and the clinical treatment is poor. At present, because of the popularity of renal artery color Doppler ultrasound, CT angiography, magnetic resonance angiography, its diagnosis is not difficult, but the treatment of ARAS is still in progress. Percutaneous renal artery angioplasty (PTRA) and percutaneous renal artery stenting (PTRAS) have been the preferred treatment for ARAS. However, several large randomized clinical studies in recent years have shown that renal artery stents are heavier in blood supply. There is no significant difference in the prognosis of ARAS patients between the two groups, and these studies and conclusions have aroused extensive controversy among many scholars. This makes the choice of specific treatment options for ARAS patients a practical problem for clinicians. This article reviews the pathophysiological mechanism of ARAS, the controversy of interventional therapy, the diagnostic and preoperative predictors, and the progress of treatment.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692
本文编号：2187546
[Abstract]:Atherosclerotic renal artery stenosis (ARAS) is a disease caused by stenosis or occlusion of renal artery trunk and its branches caused by atherosclerosis. In China, atherosclerosis has become the primary cause of renal artery stenosis (RAS) and gradually exceeds glucose. Urinary nephropathy is the fastest growing cause of end-stage renal disease. The pathophysiological mechanism of ARAS is extremely complex, which makes the clinical manifestations of ARAS diverse and the clinical treatment is poor. At present, because of the popularity of renal artery color Doppler ultrasound, CT angiography, magnetic resonance angiography, its diagnosis is not difficult, but the treatment of ARAS is still in progress. Percutaneous renal artery angioplasty (PTRA) and percutaneous renal artery stenting (PTRAS) have been the preferred treatment for ARAS. However, several large randomized clinical studies in recent years have shown that renal artery stents are heavier in blood supply. There is no significant difference in the prognosis of ARAS patients between the two groups, and these studies and conclusions have aroused extensive controversy among many scholars. This makes the choice of specific treatment options for ARAS patients a practical problem for clinicians. This article reviews the pathophysiological mechanism of ARAS, the controversy of interventional therapy, the diagnostic and preoperative predictors, and the progress of treatment.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692
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