摘要
目的探讨早期介入治疗对动脉粥样硬化性肾动脉狭窄合并脑动脉狭窄的疗效和临床意义。方法40例经动脉造影确诊为脑动脉狭窄的患者同时进行肾动脉造影,对其中同时合并肾动脉狭窄和脑动脉狭窄者采取联合介入治疗,并对治疗前后的血压、血脂、尿蛋白、肾功能及用药情况进行比较和分析。结果40例患者中12例为肾动脉狭窄合并脑动脉狭窄(30%)。肾动脉病变血管18条(狭窄比例均≥50%),脑动脉病变血管21条(血管闭塞或狭窄比例≥50%者16条)。对其中的13条肾动脉、14条脑动脉分别进行血管成形术或血管成形术+支架植入术。手术成功率(病变血管开通≥80%):肾动脉狭窄者92%,脑动脉狭窄者87%。6～12个月后血管开通率:肾动脉狭窄者85%,脑动脉狭窄者86%。追踪观察(25±6)个月,83%的患者血压降到140/90mmHg(1mmHg=0.133kPa)以下,患者平均收缩压、舒张压均有不同程度下降;24h尿蛋白定量下降,肌酐清除率上升。降压药由治疗前平均服用3.2种减少到1.3种。均P<0.01或0.05。结论肾动脉狭窄合并脑动脉狭窄进行介入治疗对患者的预后有较大影响。大部分患者高血压可治愈,肾功能得到改善。
Objective To evaluate the effcacy and clinical significance of early interventional therapy for patients with atherosclerotic renal artery stenosis complicated with cerebral artery stenosis.Methods Both carotid and renal arteriography were performed in 40 patients with cerebral artery stenosis. Combined interventional therapy was adopted in patients with cerebral artery stenosis complicated with renal artery stenosis. Clinical and laboratory data, including blood pressure, blood lipid, urine protein, renal function and use of antihypertensive drugs, were compared and analyzed before and after intervention.Results Cerebral artery stenosis was confirmed in 40 petients, 12 of them associated with renal artery stenosis (30%).Arteriography showed 18 renal arteries were damaged (more than 50% of their lumen narrowed),and 21 cerebral arteries were damaged (16 arteries with more than 50% of their lumen occluded or narrowed). Percutaneous transluminal renal angioplasty (PTRA) or PTRA plus stent implantation (SP) were performed in 13 renal arteries and 14 cerebral aretries, with primary technical success rate (more than 80% of vessels patent) of 92% for patients with renal artery stenosis and 87% for those with cerebral artery stenosis, respectively.6 to 12 months after intervention, patency rate was 85% for patients with renal artery stenosis and 86% for those with cerebral artery stenosis, repsectively. The patients were followed up for an average of (25±6) months, and their systolic blood pressure (SBP) decreased from (160±18) mm Hg to (135±9) mm Hg in average (P<0.01) and their diastolic blood pressure (DBP) decreased from (86±14) mm Hg to (78±11) mm Hg (P<0.05).and 83% of hypertensives became normotensive.(blood pressure less than 140/90 mm Hg).Quantity of urine protein (mg/24 h) decreased from 420±325 to 258±243 (P<0.01) in average. Creatinine clearance rate (Ccr) increased from (71±13) ml/min to (80±9) ml/min in average (P<0.01). And, use of antihypertensive drugs reduced significantly from 3.2 kinds before intervention to 1.3 kinds after it in average (P<0.001)Conclusions There was an important effect on prognosis of the patients with both renal and cerebral artery stenosis with early successful interventional therapy, with improvement of renal function in most patients and 83% of hypertensives becoming normotensive
出处
《中华全科医师杂志》
2005年第6期355-358,共4页
Chinese Journal of General Practitioners
