【摘要】：粥樣硬化性腎動(dòng)脈狹窄(atherosclerotic renal artery stenosis,ARAS)是指動(dòng)脈粥樣硬化導(dǎo)致的腎動(dòng)脈主干及其分支動(dòng)脈的狹窄或閉塞性所致的一種疾病。在我國(guó)動(dòng)脈粥樣硬化已經(jīng)成為腎動(dòng)脈狹窄(renal artery stenosis,RAS)的首要病因,并逐漸超過(guò)糖尿病腎病,成為終末期腎病增長(zhǎng)最快的原因。ARAS的病理生理機(jī)制極為復(fù)雜,這也是使得ARAS臨床表現(xiàn)多樣,臨床治療效果欠佳。目前由于腎動(dòng)脈彩超、CT血管造影術(shù)、磁共振血管成像術(shù)的普及使得其診斷方面并不困難,但ARAS在的治療方面尚無(wú)任何公認(rèn)最佳的治療藥物或者治療手段。經(jīng)皮經(jīng)腔腎動(dòng)脈成形術(shù)(percutaneous renal artery angioplasty,PTRA)及支架植入術(shù)(percutaneous renal artery stenting,PTRAS)曾經(jīng)作為ARAS的首選治療方法。但近年來(lái)幾個(gè)大型隨機(jī)臨床研究得出腎動(dòng)脈支架血運(yùn)重建與藥物治療對(duì)預(yù)后的影響無(wú)顯著差別的結(jié)論,而這些研究及結(jié)論引起眾多學(xué)者的廣泛爭(zhēng)議。這使得ARAS患者具體治療方案的選擇成為困擾臨床醫(yī)生的實(shí)際問(wèn)題。近年來(lái)新的國(guó)內(nèi)外研究顯示保證介入治療療效的關(guān)鍵在于術(shù)前預(yù)測(cè)指標(biāo)的選擇和適應(yīng)癥的把握。本文就ARAS病理生理機(jī)制、介入治療的爭(zhēng)議、診斷與術(shù)前預(yù)測(cè)指標(biāo)、治療的研究進(jìn)展進(jìn)行綜述。
[Abstract]:Atherosclerotic renal artery stenosis (ARAS) is a disease caused by stenosis or occlusion of renal artery trunk and its branches caused by atherosclerosis. In China, atherosclerosis has become the primary cause of renal artery stenosis (RAS) and gradually exceeds glucose. Urinary nephropathy is the fastest growing cause of end-stage renal disease. The pathophysiological mechanism of ARAS is extremely complex, which makes the clinical manifestations of ARAS diverse and the clinical treatment is poor. At present, because of the popularity of renal artery color Doppler ultrasound, CT angiography, magnetic resonance angiography, its diagnosis is not difficult, but the treatment of ARAS is still in progress. Percutaneous renal artery angioplasty (PTRA) and percutaneous renal artery stenting (PTRAS) have been the preferred treatment for ARAS. However, several large randomized clinical studies in recent years have shown that renal artery stents are heavier in blood supply. There is no significant difference in the prognosis of ARAS patients between the two groups, and these studies and conclusions have aroused extensive controversy among many scholars. This makes the choice of specific treatment options for ARAS patients a practical problem for clinicians. This article reviews the pathophysiological mechanism of ARAS, the controversy of interventional therapy, the diagnostic and preoperative predictors, and the progress of treatment.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692

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