经皮肾动脉支架成形术在移植肾和动脉粥样硬化性肾动脉狭窄中的应用价值及比较
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摘要
目的:探讨经皮肾动脉成形支架植入术(Percutaneous transluminal renal stent,PTRS)治疗移植肾肾动脉狭窄(Transplant renal artery stenosis,TRAS)与动脉粥样硬化性肾动脉狭窄(Atherosclerotic renal artery stenosis,ARAS)的疗效差异。方法:回顾性分析我院2010—2017年TRAS和ARAS的患者各30例,对PTRS治疗前后的肌酐、收缩压以及术后再次狭窄的情况进行统计学分析,比较两组治疗的疗效差异。结果:对于TRAS组,肌酐、收缩压由术前的(204.1±58.3) mmol/L、(167±18) mmHg(1 mmHg=0.133 kPa),术后3月降为(119.8±43.1) mmol/L(P<0.05)、(136±12) mmHg(P<0.05);术后1年降为(116.1±27.6) mmol/L(P<0.05)、(137±9) mmHg(P<0.05);术后3年降为(118.6±30.2) mmol/L(P<0.05)、(133±8) mmHg(P<0.05)。对于ARAS组,肌酐、收缩压由术前的(101.2±11.3) mmol/L、(165±20) mmHg,术后3月为(100.3±21.2) mmol/L(P>0.05)、(142±10) mmHg(P<0.05);术后1年为(81.3±23.4) mmol/L(P>0.05)、(141±17) mmHg(P<0.05);术后3年为(97.0±18.1) mmol/L(P>0.05)、(144±20) mmHg(P<0.05)。在术后再狭窄方面,术后6月,TRAS组和ARAS组支架再狭窄的比例分别为13.3%、6.7%(P<0.05);术后3年,TRAS组和ARAS组支架再狭窄比例分别为14.3%、25.0%(P<0.05)。结论:PTRS对于ARAS患者和TRAS患者均有良好的临床疗效,相较于ARAS患者,PTRS在TRAS患者中有着相对较低的再狭窄率。
Objective: To evaluate and compare the value of percutaneous transluminal renal stent(PTRS) in the treatment of transplant renal artery stenosis(TRAS) and atherosclerotic renal artery stenosis(ARAS). Methods: Thirty cases selected from TRAS and ARAS in 2010—2017 in our hospital, divided into group TRAS and group ARAS. Statistical analysis was performed on creatinine, systolic blood pressure, and postoperative restenosis before and after stent implantation. The systolic blood pressure and postoperative restenosis were compared between two groups and the restenosis of the two groups was followed up. Results: For group TRAS, creatinine and systolic blood pressure were improved postoperatively, creatinine and systolic blood pressure were(204.1±58.3) mmol/L and(167±18) mmHg(1 mmHg=0.133 kPa) before operation, and decreased to(119.8±43.1) mmol/L and(136±12) mmHg(P<0.05) after 3 months, decreased to(116.1±27.6) mmol/L(P<0.05) and(137±9) mmHg(P<0.05) after 1 year, decreased to(118.6±30.2) mmol/L(P<0.05) and(133±8) mmHg(P<0.05) after 3 years. The statistically difference was significantly performed between preoperative and postoperative results(P<0.05). For group ARAS, creatinine and systolic blood pressure were improved postoperative, creatinine and systolic blood pressure were(101.2±11.3) mmol/L and(165±20) mmHg before operation, and decreased to(100.3±21.2) mmol/L(P>0.05) and(142±10) mmHg(P<0.05) after 3 months,decreased to(81.3 ±23.4) mmol/L(P >0.05) and(141 ±17) mmHg(P <0.05) after 1 year, decreased to(97.0 ±18.1) mmol/L(P >0.05)and(144±20) mmHg(P<0.05) after 3 years. For the restenosis after the operation, the proportions of stent restenosis in group TRAS and group ARAS were 13.3% and 6.7% respectively after 6 months. The proportions of moderate and severe renal artery stenosis in group TRAS and group ARAS were 14.3% and 25.0% respectively after 3 years. The statistically difference was significantly performed between preoperative and postoperative results(P <0.05). Conclusion: PTRS has good clinical efficacy for ARAS patients and TRAS patients. Compared with ARAS patients, PTRS has relatively lower restenosis rate in TRAS patients.
Objective: To evaluate and compare the value of percutaneous transluminal renal stent(PTRS) in the treatment of transplant renal artery stenosis(TRAS) and atherosclerotic renal artery stenosis(ARAS). Methods: Thirty cases selected from TRAS and ARAS in 2010—2017 in our hospital, divided into group TRAS and group ARAS. Statistical analysis was performed on creatinine, systolic blood pressure, and postoperative restenosis before and after stent implantation. The systolic blood pressure and postoperative restenosis were compared between two groups and the restenosis of the two groups was followed up. Results: For group TRAS, creatinine and systolic blood pressure were improved postoperatively, creatinine and systolic blood pressure were(204.1±58.3) mmol/L and(167±18) mmHg(1 mmHg=0.133 kPa) before operation, and decreased to(119.8±43.1) mmol/L and(136±12) mmHg(P<0.05) after 3 months, decreased to(116.1±27.6) mmol/L(P<0.05) and(137±9) mmHg(P<0.05) after 1 year, decreased to(118.6±30.2) mmol/L(P<0.05) and(133±8) mmHg(P<0.05) after 3 years. The statistically difference was significantly performed between preoperative and postoperative results(P<0.05). For group ARAS, creatinine and systolic blood pressure were improved postoperative, creatinine and systolic blood pressure were(101.2±11.3) mmol/L and(165±20) mmHg before operation, and decreased to(100.3±21.2) mmol/L(P>0.05) and(142±10) mmHg(P<0.05) after 3 months,decreased to(81.3 ±23.4) mmol/L(P >0.05) and(141 ±17) mmHg(P <0.05) after 1 year, decreased to(97.0 ±18.1) mmol/L(P >0.05)and(144±20) mmHg(P<0.05) after 3 years. For the restenosis after the operation, the proportions of stent restenosis in group TRAS and group ARAS were 13.3% and 6.7% respectively after 6 months. The proportions of moderate and severe renal artery stenosis in group TRAS and group ARAS were 14.3% and 25.0% respectively after 3 years. The statistically difference was significantly performed between preoperative and postoperative results(P <0.05). Conclusion: PTRS has good clinical efficacy for ARAS patients and TRAS patients. Compared with ARAS patients, PTRS has relatively lower restenosis rate in TRAS patients.
引文
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[14]杨延皓,李恩源,陈浩,等.同种异体肾移植术后早期肾动脉狭窄诊疗的回顾性研究[J].实用临床医药杂志,2018,22(9):11-15.
[15]Chen W,Kayler LK,Zand MS,et al.Transplant renal artery stenosis:clinical manifestations,diagnosis and therapy[J].Clin Kidney J,2015,8(1):71-78.
[16]Zeller T,Krankenberg H,Erglis A,et al.A randomized,multicenter,prospective study comparing best medical treatment versus best medical treatment plus renal artery stenting in patients with hemodynamically relevant atherosclerotic renal artery stenosis(RADAR)-one-year results of a pre-maturely terminated study[J].Trials,2017,18(1):380.
[17]李丽,盖鲁粤,杨庭树,等.肾动脉狭窄患者的临床特征及介入诊治变迁[J].中华内科杂志,2005,44(11):811-813.
[18]de Leeuw PW,Postma CT,Spiering W,et al.Atherosclerotic Renal Artery Stenosis:Should we Intervene Earlier?[J].Curr Hypertens Rep,2018,20(4):35.
[19]Estrada CC,Musani M,Darras F,et al.5 Years Experience With Drug Eluting and Bare Metal Stents as Primary Intervention in Transplant Renal Artery Stenosis[J].Transplant Direct,2017,3(2):e128.
[2]Bruno S,Remuzzi G,Ruggenenti P.Transplant renal artery stenosis[J].J Am Soc Nephrol,2004,15(1):134-141.
[3]Tafur-Soto JD,White CJ.Renal artery stenosis[J].Cardiol Clin,2015,33(1):59-73.
[4]颜红兵,王嘉莉,焦媛.美国成人肾动脉狭窄诊断和介入治疗指南解读[J].中国介入心脏病学杂志,2003,11(6):326-327.
[5]张春莉,刘琨,陈飞,等.彩色多普勒超声对老年肾动脉狭窄程度诊断准确性的评估[J].中华老年心脑血管病杂志,2017,19(12):1268-1271.
[6]Parikh SA,Shishehbor MH,Gray BH,et al.SCAI expert consensus statement for renal artery stenting appropriate use[J].Catheter Cardiovasc Interv,2014,84(7):1163-1171.
[7]何海涛,刘建秦,周桂娅.肾动脉狭窄性高血压的介入治疗临床分析[J].临床军医杂志,2012,40(1):148-150.
[8]于杨,张燕,陶卉,等.肾血管性高血压与原发性高血压患者24h动态血压的差异性[J].实用医学杂志,2016,32(13):2196-2198.
[9]郑德裕.肾血管性高血压的诊断与治疗[J].人民军医,2003,46(3):158-161.
[10]Valle L,Cavalcante RN,Motta-Leal-Filho JM,et al.Evaluation of the efficacy and safety of endovascular management for transplant renal artery stenosis[J].Clinics(Sao Paulo),2017,72(12):773-779.
[11]Bessede T,Droupy S,Hammoudi Y,et al.Surgical prevention and management of vascular complications of kidney transplantation[J].Transpl Int,2012,25(9):994-1001.
[12]Srivastava A,Kumar J,Sharma S,et al.Vascular complication in live related renal transplant:An experience of 1945 cases[J].Indian J Urol,2013,29(1):42-47.
[13]Li X,Zhang J,Meng Y,et al.Transplant renal artery stenosis caused by the stretch of an artey branch:a case report and literature review[J].BMC Nephrol,2018,19(1):56.
[14]杨延皓,李恩源,陈浩,等.同种异体肾移植术后早期肾动脉狭窄诊疗的回顾性研究[J].实用临床医药杂志,2018,22(9):11-15.
[15]Chen W,Kayler LK,Zand MS,et al.Transplant renal artery stenosis:clinical manifestations,diagnosis and therapy[J].Clin Kidney J,2015,8(1):71-78.
[16]Zeller T,Krankenberg H,Erglis A,et al.A randomized,multicenter,prospective study comparing best medical treatment versus best medical treatment plus renal artery stenting in patients with hemodynamically relevant atherosclerotic renal artery stenosis(RADAR)-one-year results of a pre-maturely terminated study[J].Trials,2017,18(1):380.
[17]李丽,盖鲁粤,杨庭树,等.肾动脉狭窄患者的临床特征及介入诊治变迁[J].中华内科杂志,2005,44(11):811-813.
[18]de Leeuw PW,Postma CT,Spiering W,et al.Atherosclerotic Renal Artery Stenosis:Should we Intervene Earlier?[J].Curr Hypertens Rep,2018,20(4):35.
[19]Estrada CC,Musani M,Darras F,et al.5 Years Experience With Drug Eluting and Bare Metal Stents as Primary Intervention in Transplant Renal Artery Stenosis[J].Transplant Direct,2017,3(2):e128.