肾脏滤过分数对单侧肾动脉狭窄腔内治疗选择的影响

发布时间：2018-11-20 13:44

【摘要】：目的探讨肾脏滤过分数(filtration fraction,FF)对单侧肾动脉狭窄腔内治疗的影响。方法 2014年5月~2015年11月我们对31例单侧肾动脉狭窄行经皮肾动脉成形支架植入术(percutaneous transluminal renal angioplasty and stent,PTRAS),分析患者术前与术后健侧肾脏、患侧肾脏肾小球滤过率(glomerular filtration rate,GFR)、肾有效血浆流量(effective renal plasma flow,ERPF)、FF变化,观察患者血压(收缩压)和服用降压药种类的变化。结果 31例PTRAS均成功。术前患侧GFR(28.79±12.88)ml/min,明显低于健侧(41.72±14.23)ml/min(t=-3.749,P=0.000);术前患侧ERPF(124.55±49.36)ml/min,明显低于健侧(186.92±43.22)ml/min(t=-5.293,P=0.000)。术后患侧肾脏GFR(30.40±12.85)ml/min,明显高于术前(28.79±12.88)ml/min(t=-2.236,P=0.003);术后患侧肾脏ERPF(137.46±47.00)ml/min,明显高于术前(124.55±49.36)ml/min(t=-5.017,P=0.000);术后患侧FF(22.24±5.52)%较术前(24.93±8.68)%明显降低(更趋近于正常值)(t=2.577,P=0.015)。术后患侧GFR(30.39±12.84)ml/min,仍明显低于健侧(40.31±13.87)ml/min(t=-2.920,P=0.005);术后患侧ERPF(137.46±47.00)ml/min,明显低于健侧(178.25±42.25)ml/min(t=-3.593,P=0.001)。术后患侧FF(22.24±5.52)%与健侧FF(22.52±5.73)%无统计学差异(t=-0.195,P=0.846)。术前FF相对正常的患肾,术后FF(21.45±3.35)%较术前FF(21.77±3.26)%变化较小(t=0.847,P=0.407);术前FF明显升高的患肾,术后FF(27.21±5.34)%较术前FF(36.88±6.00)%明显降低(趋向正常值)(t=3.495,P=0.010)。术前肌酐(96.97±25.81)μmol/L与术后(94.39±22.45)μmol/L无统计学差异(t=0.420,P=0.676)。术后收缩压(144.4±11.1)mm Hg较术前(158.5±13.7)mm Hg明显下降(t=7.804,P=0.000);服用降压药物种类术后(2.6±0.6)种,较术前(3.0±0.5)种明显减少(t=4.655,P=0.000)。结论对于肾动脉狭窄患者,分肾FF是了解肾脏缺血病理生理进程的有益指标。对于单侧肾动脉狭窄患者,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 investigate the effect of renal filtration fraction (filtration fraction,FF) on endovascular treatment of unilateral renal artery stenosis. Methods from May 2014 to November 2015, 31 patients with unilateral renal artery stenosis underwent percutaneous renal arterioplasty stent implantation (percutaneous transluminal renal angioplasty and stent,PTRAS). The (glomerular filtration rate, of healthy kidney and affected kidney were analyzed before and after operation. The changes of blood pressure (SBP) and the types of antihypertensive drugs were observed in patients with GFR), renal effective plasma flow (effective renal plasma flow,ERPF), FF). Results all 31 cases of PTRAS were successful. Preoperative GFR of the affected side (28.79 卤12.88) ml/min, was significantly lower than that of the healthy side (41.72 卤14.23 ml/min) (TV-3.749 ml/min). The preoperative ERPF of the affected side (124.55 卤49.36) ml/min, was significantly lower than that of the healthy side (186.92 卤43.22 ml/min) (t = 5.293). The GFR of the affected kidney (30.40 卤12.85) ml/min, was significantly higher than that of the pre-operation (28.79 卤12.88) ml/min (t = -2.236) P0. 003; The ERPF of the affected kidney (137.46 卤47.00) ml/min, was significantly higher than that of the preoperative (124.55 卤49.36) ml/min (t = 5.017). Postoperative FF (22.24 卤5.52)% was significantly lower than that before operation (24.93 卤8.68)%. The GFR of the affected side (30.39 卤12.84) ml/min, was significantly lower than that of the healthy side (40.31 卤13.87 ml/min) (t = 2.920). The ERPF of the affected side (137.46 卤47.00) ml/min, was significantly lower than that of the healthy side (178.25 卤42.25 ml/min). There was no significant difference in postoperative FF (22.24 卤5.52)% and healthy side FF (22.52 卤5.73)% (t = 0.195, P < 0. 846). Compared with preoperative FF (21.77 卤3.26)%, FF (21.45 卤3.35)% and FF (0.847 卤3.26)% had less change after operation (t = 0.847, P < 0. 407). FF (27.21 卤5.34)% before operation was significantly lower than that before FF (36.88 卤6.00)% (P < 0.05). There was no significant difference between preoperative creatinine (96.97 卤25.81) 渭 mol/L and postoperative (94.39 卤22.45) 渭 mol/L (tr 0.420 渭 mol/L). The systolic blood pressure (144.4 卤11. 1) mm Hg) was significantly lower than that before operation (158.5 卤13. 7) mm Hg). There were (2.6 卤0.6) kinds of antihypertensive drugs after operation, which was significantly lower than that before (3.0 卤0.5) (t = 4.655p ~ (0.000). Conclusion in patients with renal artery stenosis, FF is a useful index to understand the pathophysiological process of renal ischemia. For patients with unilateral renal artery stenosis, preoperative FF was significantly increased or FF was relatively normal, which should be regarded as an indication of renal artery stenting.
【作者单位】：北京大学第三医院介入血管外科;
【分类号】：R699

【参考文献】