摘要
目的通过比较动脉粥样硬化性肾动脉狭窄(ARAS)患者介入治疗前后血压、肾功能,尤其是分侧肾动态显像测定的肾小球滤过率(Tm-GFR)等指标的变化,评估ARAS介入治疗的疗效,并通过统计分析探索能使肾功能得到最大获益的基础Tm-GFR,为临床选择介入治疗适应证提供依据。方法分别比较单侧狭窄组和双侧狭窄组介入治疗前后血压指标和肾功能指标的变化;比较肾动脉狭窄≥50%的肾脏(患侧肾脏)介入前后的分侧Tm-GFR;对受累肾脏介入前分侧Tm-GFR与介入后分侧Tm-GFR增高百分率进行相关分析;以介入前的基础分侧Tm-GFR为检验变量制作Tm-GFR改善与否的受试者工作特征(ROC)曲线,得出能够使肾小球滤过率在介入治疗后获得改善的最佳切点。结果所有ARAS患者介入治疗后的诊室收缩压、舒张压与24h平均收缩压、舒张压低于介入前,并且介入治疗后的用药数量较治疗前减少(均P<0.01),总Tm-GFR增高[(71.9±21.9)比(65.8±24.4)mL/(min·1.73m2),P<0.05]。介入治疗前后,单侧ARAS患者的总Tm-GFR无明显变化,患侧Tm-GFR增高[(34.5±15.4)比(30.2±13.9)mL/(min·1.73m2),P<0.05],双侧ARAS患者的总Tm-GFR和介入前较低侧Tm-GFR增高[分别为(67.1±10.2)比(52.5±21.1),(28.8±7.7)比(17.4±8.9)mL/(min·1.73m2),均P<0.05]。介入前分侧Tm-GFR与介入后分侧Tm-GFR增高百分率呈负相关(r=-0.632,P<0.01)。ROC曲线发现术前分侧Tm-GFR≤25mL/(min·1.73m2)的肾脏行介入治疗其分侧Tm-GFR可获得最大程度提高。结论ARAS患者介入治疗后血压可以得到控制,尤其是收缩压可以得到明显改善。Tm-GFR≤25mL/(min·1.73m2)的患侧肾脏,介入治疗后肾小球滤过率明显增高。
Objective To evaluate the efficacy of interventional treatment for atherosclerotic renal artery stenosis （ARAS） by comparing the changes of blood pressure （BP）, kidney function especially ipsilateral glomerular filtra- tion rate ITm-GFR） measured by renal dynamic imaging and other indicators before and after interventional treat- ment. Meanwhile, to explore a basic Tm-GFR, with which one can get the maximum benefit from interventional treatment to facilitate choosing proximal indications. Methods Compared the changes of BP and renal function in- dicators in unilateral and bilateral ARAS group, as well as the ipsilateral Tm-GFR in patients who had ≥50% renal artery stenosis before and after interventional treatment. Scatter plot was used to analyse the increasing percentage of Tm-GFR of affected kidney after interventionaI treatment. Receiver operating characteristic {ROC） curve was made by using basic ipsilateral Tm-GFR as variable to find the best cutoff to maximize the benefit. Results For ARAS patients, the clinic systolic and diastolic BP, average ambulatory systolic and diastolic BP were significantly lower after intervention treatment （P〈 0.01 ）. Moreover, the number of drugs used was significantly reduced, while total Tm-GFR increased after intervention [-（71.9±21.9） vs （65.8±24.4）mL/（min 1.73 m2 , P〈0.05]. In unilateral ARAS patients, Tm-GFR of affected kidney increased, with no material changes of total Tm-GFR. While in bilateral ARAS patients, total Tm-GFR [{ 67.1 4±10.2 ） vs （ 52.5 ± 21.1 ） mL/{ min 1.73 m2 ） and the lowered ipsilateral Tm-GFR [{28.8±7.7） vs {17.4±8.9）mL/（min 1.73 m2] were both significantly increased after intervention. There was a negative correlation between the increasing percentages of ipsilateral Tm-GFR after intervention {r= -0. 632, P〈0.01 ）. ROC curves indicated that patients with Tm-GFR≤25 mL/（min 1.73 m2 ） had the greatest benefition from intervention. Conclusions ARAS patients will have an improved BP, especially systolic BP. The Tm-GFR of affected kidney with basic Tm-GFR≤25 mL/（min 1.73 m2 ） will be greatly im- proved by interventional therapy.
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2014年第4期353-359,共7页
Chinese Journal of Hypertension
关键词
动脉粥样硬化性肾动脉狭窄
介入治疗
肾动态显像测定的肾小球滤过率
血压
肾功能
Atherosclerotic renal artery stenosis
Interventional treatment
Glomerular filtration rate measured by 99Tcm_DTPA renal dynamic imaging
Blood pressure
Renal function
