發(fā)布時間：2018-11-20 13:44

【摘要】：目的探討腎臟濾過分?jǐn)?shù)(filtration fraction,FF)對單側(cè)腎動脈狹窄腔內(nèi)治療的影響。方法 2014年5月~2015年11月我們對31例單側(cè)腎動脈狹窄行經(jīng)皮腎動脈成形支架植入術(shù)(percutaneous transluminal renal angioplasty and stent,PTRAS),分析患者術(shù)前與術(shù)后健側(cè)腎臟、患側(cè)腎臟腎小球濾過率(glomerular filtration rate,GFR)、腎有效血漿流量(effective renal plasma flow,ERPF)、FF變化,觀察患者血壓(收縮壓)和服用降壓藥種類的變化。結(jié)果 31例PTRAS均成功。術(shù)前患側(cè)GFR(28.79±12.88)ml/min,明顯低于健側(cè)(41.72±14.23)ml/min(t=-3.749,P=0.000);術(shù)前患側(cè)ERPF(124.55±49.36)ml/min,明顯低于健側(cè)(186.92±43.22)ml/min(t=-5.293,P=0.000)。術(shù)后患側(cè)腎臟GFR(30.40±12.85)ml/min,明顯高于術(shù)前(28.79±12.88)ml/min(t=-2.236,P=0.003);術(shù)后患側(cè)腎臟ERPF(137.46±47.00)ml/min,明顯高于術(shù)前(124.55±49.36)ml/min(t=-5.017,P=0.000);術(shù)后患側(cè)FF(22.24±5.52)%較術(shù)前(24.93±8.68)%明顯降低(更趨近于正常值)(t=2.577,P=0.015)。術(shù)后患側(cè)GFR(30.39±12.84)ml/min,仍明顯低于健側(cè)(40.31±13.87)ml/min(t=-2.920,P=0.005);術(shù)后患側(cè)ERPF(137.46±47.00)ml/min,明顯低于健側(cè)(178.25±42.25)ml/min(t=-3.593,P=0.001)。術(shù)后患側(cè)FF(22.24±5.52)%與健側(cè)FF(22.52±5.73)%無統(tǒng)計學(xué)差異(t=-0.195,P=0.846)。術(shù)前FF相對正常的患腎,術(shù)后FF(21.45±3.35)%較術(shù)前FF(21.77±3.26)%變化較小(t=0.847,P=0.407);術(shù)前FF明顯升高的患腎,術(shù)后FF(27.21±5.34)%較術(shù)前FF(36.88±6.00)%明顯降低(趨向正常值)(t=3.495,P=0.010)。術(shù)前肌酐(96.97±25.81)μmol/L與術(shù)后(94.39±22.45)μmol/L無統(tǒng)計學(xué)差異(t=0.420,P=0.676)。術(shù)后收縮壓(144.4±11.1)mm Hg較術(shù)前(158.5±13.7)mm Hg明顯下降(t=7.804,P=0.000);服用降壓藥物種類術(shù)后(2.6±0.6)種,較術(shù)前(3.0±0.5)種明顯減少(t=4.655,P=0.000)。結(jié)論對于腎動脈狹窄患者,分腎FF是了解腎臟缺血病理生理進(jìn)程的有益指標(biāo)。對于單側(cè)腎動脈狹窄患者,術(shù)前FF顯著增高或FF相對正常,應(yīng)視為腎動脈支架植入術(shù)的手術(shù)指征。
[Abstract]:Objective to investigate the effect of renal filtration fraction (filtration fraction,FF) on endovascular treatment of unilateral renal artery stenosis. Methods from May 2014 to November 2015, 31 patients with unilateral renal artery stenosis underwent percutaneous renal arterioplasty stent implantation (percutaneous transluminal renal angioplasty and stent,PTRAS). The (glomerular filtration rate, of healthy kidney and affected kidney were analyzed before and after operation. The changes of blood pressure (SBP) and the types of antihypertensive drugs were observed in patients with GFR), renal effective plasma flow (effective renal plasma flow,ERPF), FF). Results all 31 cases of PTRAS were successful. Preoperative GFR of the affected side (28.79 鹵12.88) ml/min, was significantly lower than that of the healthy side (41.72 鹵14.23 ml/min) (TV-3.749 ml/min). The preoperative ERPF of the affected side (124.55 鹵49.36) ml/min, was significantly lower than that of the healthy side (186.92 鹵43.22 ml/min) (t = 5.293). The GFR of the affected kidney (30.40 鹵12.85) ml/min, was significantly higher than that of the pre-operation (28.79 鹵12.88) ml/min (t = -2.236) P0. 003; The ERPF of the affected kidney (137.46 鹵47.00) ml/min, was significantly higher than that of the preoperative (124.55 鹵49.36) ml/min (t = 5.017). Postoperative FF (22.24 鹵5.52)% was significantly lower than that before operation (24.93 鹵8.68)%. The GFR of the affected side (30.39 鹵12.84) ml/min, was significantly lower than that of the healthy side (40.31 鹵13.87 ml/min) (t = 2.920). The ERPF of the affected side (137.46 鹵47.00) ml/min, was significantly lower than that of the healthy side (178.25 鹵42.25 ml/min). There was no significant difference in postoperative FF (22.24 鹵5.52)% and healthy side FF (22.52 鹵5.73)% (t = 0.195, P < 0. 846). Compared with preoperative FF (21.77 鹵3.26)%, FF (21.45 鹵3.35)% and FF (0.847 鹵3.26)% had less change after operation (t = 0.847, P < 0. 407). FF (27.21 鹵5.34)% before operation was significantly lower than that before FF (36.88 鹵6.00)% (P < 0.05). There was no significant difference between preoperative creatinine (96.97 鹵25.81) 渭 mol/L and postoperative (94.39 鹵22.45) 渭 mol/L (tr 0.420 渭 mol/L). The systolic blood pressure (144.4 鹵11. 1) mm Hg) was significantly lower than that before operation (158.5 鹵13. 7) mm Hg). There were (2.6 鹵0.6) kinds of antihypertensive drugs after operation, which was significantly lower than that before (3.0 鹵0.5) (t = 4.655p ~ (0.000). Conclusion in patients with renal artery stenosis, FF is a useful index to understand the pathophysiological process of renal ischemia. For patients with unilateral renal artery stenosis, preoperative FF was significantly increased or FF was relatively normal, which should be regarded as an indication of renal artery stenting.
【作者單位】： 北京大學(xué)第三醫(yī)院介入血管外科;
【分類號】：R699

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 金仲慧;張龍;張燕燕;李選;朱慧慈;;腎素-血管緊張素檢測在經(jīng)皮腔內(nèi)腎動脈成形術(shù)中的臨床價值[J];中國微創(chuàng)外科雜志;2014年11期

2 劉波;呂建峰;粟治洲;王剛;任夢宇;周亮;遲路湘;;動脈粥樣硬化性腎動脈狹窄傳統(tǒng)危險因素的Meta分析[J];第三軍醫(yī)大學(xué)學(xué)報;2014年19期

3 林偉,鄔恒夫,葉廣春,魏學(xué)立,歐陽智,武兆忠,鄧力平;~(99)Tc~m-DTPA與~(131)I-OIH雙核素腎動態(tài)顯像對腎功能的評價[J];中華核醫(yī)學(xué)雜志;2002年04期

4 饒國輝，李春億，林增桃，曾世荃;~（99m）Tc－EC腎動態(tài)顯像及有效血漿流量測定的臨床應(yīng)用[J];中國醫(yī)學(xué)影像技術(shù);1996年03期

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

1 馮琦琛;李選;欒景源;王昌明;李天潤;;腎臟濾過分?jǐn)?shù)對單側(cè)腎動脈狹窄腔內(nèi)治療選擇的影響[J];中國微創(chuàng)外科雜志;2017年01期

2 馮琦琛;李選;欒景源;王昌明;李天潤;;腎濾過分?jǐn)?shù)評價腎動脈支架植入術(shù)對動脈硬化性腎動脈狹窄的治療效果[J];北京大學(xué)學(xué)報(醫(yī)學(xué)版);2017年01期

3 葉強(qiáng);楊學(xué)志;葉祖森;殷為勇;程建華;范良好;伍曉揚(yáng);;腦梗死患者動脈粥樣硬化性腎動脈狹窄與腦供血動脈狹窄的關(guān)系[J];中國醫(yī)師進(jìn)修雜志;2016年03期

4 楊鈞顯;高強(qiáng)利;林黎;李永發(fā);;輸尿管鏡聯(lián)合經(jīng)皮腎微造瘺治療輸尿管中、下段結(jié)石合并重度腎積水[J];實用醫(yī)藥雜志;2015年09期

5 陳作觀;刁永鵬;閆盛;葉子興;李擁軍;;RAAS系統(tǒng)在評估腎動脈狹窄再開通術(shù)后療效的運(yùn)用展望[J];血管與腔內(nèi)血管外科雜志;2015年01期

6 李明;敖華;陳文祥;何愛紅;劉勇強(qiáng);張秋玲;張盛;;2型糖尿病合并腎動脈狹窄相關(guān)危險因素臨床分析[J];臨床腎臟病雜志;2014年11期

7 陳澤榮;鄭少斌;姜耀東;池曉華;張輝見;陳鵬亮;;上尿路梗阻患者解除尿路梗阻后核素腎動態(tài)顯像檢查結(jié)果變化及意義[J];山東醫(yī)藥;2012年38期

8 陳海龍;邵小南;張云;邵曉梁;;99mTc-DTPA與99mTc-EC腎動態(tài)顯像對慢性腎臟病患者腎功能判斷的臨床價值[J];亞太傳統(tǒng)醫(yī)藥;2012年04期

9 程兵;杜曉光;丁獻(xiàn)敏;謝新立;牛廣君;劉保平;;~(99)Tc~m-DTPA腎圖半排時間參考值測定[J];中華核醫(yī)學(xué)與分子影像雜志;2012年01期

10 邵小南;張瑋;;核素腎動態(tài)顯像評價腎癌患者術(shù)前腎功能的意義[J];實用醫(yī)學(xué)雜志;2011年10期

【二級參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 嚴(yán)健華;孫t畔，

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