球囊扩张术治疗肌纤维发育不良型肾动脉狭窄的临床疗效
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摘要
目的评价肾动脉球囊扩张术治疗肾动脉肌纤维性发育不良(FMD)的疗效及安全性。方法选择诊断为FMD型肾动脉狭窄患者20例(均合并有不同程度高血压)行肾动脉球囊扩张术治疗,术后随访观察患者血压变化情况、药物治疗种类、术后再狭窄及其他并发症发生等情况。结果本研究手术技术成功率为100%(20/20),再狭窄率为15%(3/20)。术后随访平均(27.15±18.97)个月,治疗后收缩压、舒张压及服用降压药种类均低于治疗前,差异具有统计学意义(P<0.05)。无肾动脉破裂、夹层、分支堵塞及血栓形成等并发症及术后不良事件。结论球囊扩张术治疗FMD型肾动脉狭窄安全有效且预后较好,并发症较少。
Objective To evaluate the efficacy and safety of balloon dilatation in the treatment of renal artery stenosis fibromuscular dysplasia(FMD). Methods A total of 20 patients confirmed as FMD complicated with different degrees of hypertension were enrolled and treated with renal artery balloon dilatation. The blood pressure changes, drug treatment types, restenosis and other complications were observed during postoperative follow-up. Results The success rate of surgical technique in this study was 100%(20/20) and the restenosis rate was 15%(3/20). The average follow-up length was(27.15±18.97) months. The systolic blood pressure, diastolic blood pressure and antihypertensive drugs using were lower than those before treatment, and the differences were statistically significant(P<0.05).Conclusion Balloon dilatation is safe, effective, and has a good prognosis for FMD renal artery stenosis with fewer complications.
Objective To evaluate the efficacy and safety of balloon dilatation in the treatment of renal artery stenosis fibromuscular dysplasia(FMD). Methods A total of 20 patients confirmed as FMD complicated with different degrees of hypertension were enrolled and treated with renal artery balloon dilatation. The blood pressure changes, drug treatment types, restenosis and other complications were observed during postoperative follow-up. Results The success rate of surgical technique in this study was 100%(20/20) and the restenosis rate was 15%(3/20). The average follow-up length was(27.15±18.97) months. The systolic blood pressure, diastolic blood pressure and antihypertensive drugs using were lower than those before treatment, and the differences were statistically significant(P<0.05).Conclusion Balloon dilatation is safe, effective, and has a good prognosis for FMD renal artery stenosis with fewer complications.
引文
[1]Persu A, Giavarini A, TouzéE, et al. European consensus on the diagnosis and management of fibromuscular dysplasia[J].J Hypertens, 2014, 32(7):1367-1378.
[2]Ralapanawa DM, Jayawickreme KP, Ekanayake EM. A case of treatable hypertension:fibromuscular dysplasia of renal arteries[J]. BMC Res Notes. 2016, 9:6.
[3]中国医疗保健国际交流促进会高血压分会,中国医师协会高血压专业委员会,中国老年医学学会高血压分会,等.中国高血压防治指南(2018年修订版)[J].中国心血管杂志, 2019, 24(1):24-56.
[4]米杰,王天有,孟玲慧,等.中国儿童青少年血压参照标准的研究制定[J].中国循证儿科杂志, 2010, 5(1):4-14.
[5]蒋小云,容丽萍.儿童高血压的诊断与治疗研究进展[J].中华实用儿科临床杂志, 2013, 28(13):1037-1040.
[6]Gavalas MV, Gasparis AP, Tassiopoulos AK, et al. Long-term follow-up for percutaneous transluminal angioplasty in renal artery fibromuscular dysplasia[J]. Int Angiol, 2015, 34(6):529-537.
[7]Olin JW, Gornik HL, Bacharach JM, et al. Fibromuscular dysplasia:stateofthescienceandcriticalunanswered questionsascientificstatementfromthe AmericanHeart Association[J]. Circulation, 2014, 129(9):1048-1078.
[8]Plouin PF, Perdu J, La Batide-Alanore A, et al. Fibromuscular dysplasia[J]. Orphanet J Rare Dis, 2007, 2:28.
[9]Noory E, Sritharan K, Zeller T. To stent or not to stent?Update on revascularization for atherosclerotic renovascular disease[J]. Curr Hypertens Rep, 2016, 18(6):45.
[10]Olin JW, Froehlich J, Gu X,et al. The united states registry for fibromuscular dysplasia:results in the first 447 patients[J].Circulation, 2012, 125(25):3182-3190.
[11]Gotts?ter A,LindbladB.Optimalmanagementofrenal artery fibromuscular dysplasia[J]. Ther Clin Risk Manag,2014, 10:583-595.
[12]SawJ,BezerraH,GornikHL,etal. Angiographicand intracoronarymanifestationsofcoronaryfibromuscular dysplasia[J]. Circulation, 2016, 133(16):1548-1559.
[13]张童.紫杉醇涂层球囊与普通球囊治疗腘动脉粥样硬化闭塞性病变的比较[D].中国中医科学院, 2017, 1-30.
[14]刘杰.新型药物涂层球囊治疗外周动脉狭窄的实验研究[D].中国人民解放军医学院, 2017:1-98.
[15]TakahashiS, Takizawa Y,NakanoS,etal. Arefractory hypertensivepatientwithfibromusculardysplasiaand multicysticdysplastickidney[J].JMedUltrason,2018,45(4):657-660.
[16]Saw J, Poulter R, Fung A, et al. Spontaneous coronary artery dissection in patients with fibromuscular dysplasia[J]. Circ Cardiovasc Interv, 2012, 5(1):134-137.
[2]Ralapanawa DM, Jayawickreme KP, Ekanayake EM. A case of treatable hypertension:fibromuscular dysplasia of renal arteries[J]. BMC Res Notes. 2016, 9:6.
[3]中国医疗保健国际交流促进会高血压分会,中国医师协会高血压专业委员会,中国老年医学学会高血压分会,等.中国高血压防治指南(2018年修订版)[J].中国心血管杂志, 2019, 24(1):24-56.
[4]米杰,王天有,孟玲慧,等.中国儿童青少年血压参照标准的研究制定[J].中国循证儿科杂志, 2010, 5(1):4-14.
[5]蒋小云,容丽萍.儿童高血压的诊断与治疗研究进展[J].中华实用儿科临床杂志, 2013, 28(13):1037-1040.
[6]Gavalas MV, Gasparis AP, Tassiopoulos AK, et al. Long-term follow-up for percutaneous transluminal angioplasty in renal artery fibromuscular dysplasia[J]. Int Angiol, 2015, 34(6):529-537.
[7]Olin JW, Gornik HL, Bacharach JM, et al. Fibromuscular dysplasia:stateofthescienceandcriticalunanswered questionsascientificstatementfromthe AmericanHeart Association[J]. Circulation, 2014, 129(9):1048-1078.
[8]Plouin PF, Perdu J, La Batide-Alanore A, et al. Fibromuscular dysplasia[J]. Orphanet J Rare Dis, 2007, 2:28.
[9]Noory E, Sritharan K, Zeller T. To stent or not to stent?Update on revascularization for atherosclerotic renovascular disease[J]. Curr Hypertens Rep, 2016, 18(6):45.
[10]Olin JW, Froehlich J, Gu X,et al. The united states registry for fibromuscular dysplasia:results in the first 447 patients[J].Circulation, 2012, 125(25):3182-3190.
[11]Gotts?ter A,LindbladB.Optimalmanagementofrenal artery fibromuscular dysplasia[J]. Ther Clin Risk Manag,2014, 10:583-595.
[12]SawJ,BezerraH,GornikHL,etal. Angiographicand intracoronarymanifestationsofcoronaryfibromuscular dysplasia[J]. Circulation, 2016, 133(16):1548-1559.
[13]张童.紫杉醇涂层球囊与普通球囊治疗腘动脉粥样硬化闭塞性病变的比较[D].中国中医科学院, 2017, 1-30.
[14]刘杰.新型药物涂层球囊治疗外周动脉狭窄的实验研究[D].中国人民解放军医学院, 2017:1-98.
[15]TakahashiS, Takizawa Y,NakanoS,etal. Arefractory hypertensivepatientwithfibromusculardysplasiaand multicysticdysplastickidney[J].JMedUltrason,2018,45(4):657-660.
[16]Saw J, Poulter R, Fung A, et al. Spontaneous coronary artery dissection in patients with fibromuscular dysplasia[J]. Circ Cardiovasc Interv, 2012, 5(1):134-137.