發(fā)布時間：2018-03-19 01:25

  本文選題：腎動脈狹窄　切入點：腎靜脈腎素測定　出處：《上海交通大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討腎靜脈血漿腎素活性（PRA）測定對腎動脈狹窄（RAS）患者介入治療后血壓變化情況的預(yù)測評估價值。 方法：選取57例2002年至2013年在上海瑞金醫(yī)院高血壓科住院的患者，高度懷疑腎動脈狹窄（RAS），測定雙側(cè)腎靜脈及下腔靜脈血漿腎素活性（PRA），并行腎動脈造影（RA）明確診斷。根據(jù)患者具體情況綜合評估決定是否行介入手術(shù)治療。記錄患者術(shù)前及術(shù)后隨訪的24小時動態(tài)血壓。將患者分為造影陰性組，雙側(cè)腎動脈狹窄組和單側(cè)腎動脈狹窄組，比較左右兩側(cè)腎靜脈PRA的區(qū)別。計算由PRA測定推導(dǎo)出來的指標(biāo)，Vich表示缺血側(cè)腎素，Vctl表示對側(cè)腎素，Viivc表示下腔靜脈腎素：Visch/Vctl RVRR：狹窄側(cè)腎靜脈PRA/正常側(cè)腎靜脈PRA、(Visch-Viivc)/Viivc：狹窄側(cè)腎靜脈PRA減下腔靜脈PRA除以下腔靜脈PRA、(Vctl-Viivc)/Viivc：正常側(cè)腎靜脈PRA減下腔靜脈PRA除以下腔靜脈PRA、Vctl/Viivc：正常側(cè)腎靜脈PRA除以下腔靜脈PRA。根據(jù)隨訪腎動脈介入治療（經(jīng)皮腔內(nèi)腎血管成形及支架植入術(shù)）后患者血壓變化情況，，將患者分為無效、改善和痊愈組，統(tǒng)計分析上述由腎靜脈PRA推導(dǎo)出的指標(biāo)對評估患者術(shù)后血壓變化的價值，探討以上指標(biāo)是否能夠區(qū)分哪些患者可以從介入手術(shù)中獲益。 結(jié)果：共57例患者，3例因拒絕行腎動脈造影予排除。20例患者腎動脈造影陰性作為對照組，34例為腎動脈狹窄（RAS），27例為單側(cè)腎動脈狹窄（Uni-RAS），7例為雙側(cè)腎動脈狹窄（Bi-RAS），病因診斷為粥樣硬化性腎動脈狹窄（ARAS）患者29例，腎動脈肌纖維發(fā)育不良（FMD）5例。其中26例患者行介入術(shù)，5例行單純球囊擴(kuò)張術(shù)，21例行支架植入術(shù)。首先我們研究了在單側(cè)腎動脈狹窄患者中，狹窄側(cè)與非狹窄側(cè)腎靜脈腎素值比較P0.05，無明顯統(tǒng)計學(xué)差異。對介入治療后隨訪的RAS患者進(jìn)行分析發(fā)現(xiàn)，從腎靜脈PRA測定推導(dǎo)出來的指標(biāo)都不能很好的區(qū)分哪些患者可以從介入手術(shù)中獲益。在單側(cè)腎動脈狹窄組RVRR＞1.5也不能有效的評估患者介入術(shù)后血壓情況。 結(jié)論：總的來說，腎靜脈血漿腎素活性測定對判斷腎動脈狹窄患者是否需要行介入術(shù)基本無意義，我們急需尋求更加可靠實用有效的指標(biāo)。
[Abstract]:Objective: to evaluate the predictive value of plasma renin activity (PRA) in patients with renal artery stenosis (Ras) after interventional therapy. Methods: 57 patients were selected from 2002 to 2013 in the Department of Hypertension, Ruijin Hospital, Shanghai. RASA was highly suspected of renal artery stenosis. The plasma renin activity of bilateral renal veins and inferior vena cava was measured. Renal arteriography was performed to make a definite diagnosis. According to the specific conditions of the patients, a comprehensive evaluation was made to determine whether or not to perform interventional surgery. The patients were recorded. 24 hours ambulatory blood pressure was followed up before and after operation. The patients were divided into two groups: negative group. Bilateral renal artery stenosis group and unilateral renal artery stenosis group, Compare the differences of PRA between left and right renal veins. Calculate the index derived from PRA measurement: Vctl indicates ischemic renin / Vctl means contralateral renin / Vctl RVRRR: narrow side renal vein PRA/ normal side renal vein PRA Visch-Viivc / Viivc: narrow side renin / Vctl RVRR: narrow side of renal vein PRA/ normal side of renal vein (PRA) Visch-Viivc / Viivc / Viivc: contralateral side. Renal vein PRA subtractive inferior vena cava PRA Vctl-Viivcn / Viivc: normal renal vein PRA subtractive inferior vena cava PRA: normal renal vein PRA except vena cava PRA. The changes of blood pressure in patients after orthoplasty and stent implantation, The patients were divided into three groups: ineffective group, improved group and cured group. The above indexes derived from renal vein PRA were statistically analyzed to evaluate the changes of blood pressure after operation, and to explore whether the above indexes could distinguish which patients could benefit from interventional surgery. Results: a total of 57 patients with renal arteriography were excluded from renal arteriography. 20 patients were negative for renal arteriography as control group. 34 patients with renal artery stenosis and 27 patients with unilateral renal artery stenosis. 7 patients with bilateral renal artery stenosis. 29 patients were diagnosed as atherosclerotic renal artery stenosis. There were 5 cases of renal artery muscular fiber dysplasia. Among them, 26 cases were treated by interventional surgery and 5 cases by balloon dilatation and 21 cases by stenting. First, we studied the patients with unilateral renal artery stenosis. There was no significant difference in renin level between the stenosis side and the non-stenosis side (P 0.05). The indexes derived from renal vein PRA could not distinguish which patients could benefit from interventional operation. RVRR > 1.5 in unilateral renal artery stenosis group could not effectively evaluate the blood pressure after interventional operation. Conclusion: in general, the determination of renin activity in renal vein plasma is of no significance in judging whether or not renal artery stenosis patients need interventional procedures. We urgently need to seek more reliable and effective indicators.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692;R544.1

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本文編號：1632218