经皮肾动脉腔内成形术治疗大动脉炎所致肾血管性高血压：10例近期效果及10年随访观察(摘要)
作者：蒋世良 黄连军 金敬琳 徐仲英 戴汝平
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 放射科(100037)
关键词：
中国循环杂志99zk101 目的：评价国人经皮肾动脉腔内成形术(PTRA)治疗大动脉炎所致肾血管性高血压的远期疗效。
方法：1983年3月至1998年9月对10例大动脉炎所致肾血管性高血压患者成功地施行了PTRA，其中男1例，女9例，平均年龄24.4岁(14～35岁)。全部患者均有临床、体检、化验及数字减影造影(DSA)资料。血压范围在260/160 mmHg～150/106 mmHg(1 mmHg=0.133 kPa)。1例PTRA 1年前因右肾动脉重度狭窄行右肾切除术，1例左肾动脉PTRA成功后，右肾施行自体肾移植。红细胞沉降率除1例轻度升高外，余9例均正常。DSA证实单侧及双侧肾动脉狭窄者分别为6例及4例，合并腹主动脉轻度狭窄者3例，合并无名动脉、腹腔动脉、肠系膜上动脉、髂动脉及肺动脉病变者各1例。10例患者于PTRA术前、术后及出院前均测血压。并采用门诊及信访方式进行了随访，平均随访时间12.1年(10～15.3年)。其中2例于PTRA术后3年施行了静脉DSA；1例PTRA术后8年施行了动脉DSA；2例于PTRA术后10年施行了电子束计算机断层摄影术(EBCT)肾动脉三维重建。全部患者均根据临床血压情况来评价PTRA的疗效。未服降压药血压≤140/90 mmHg以下者为治愈；服用降压药量较PTRA术前减少，舒张压较术前下降15%及收缩压较术前下降10%者均为改善；PTRA术后血压无变化者为无效。
, 百拇医药
结果：PTRA术后近期效果：治愈7例(70%)；改善3例(30%)；10年随访结果：治愈6例(60%)，其中1例为右肾切除术1年后又发生左肾动脉狭窄，施行PTRA术后10年红细胞沉降率升高达110 mm/h,但血压仍维持在140/0～60 mmHg,彩色多普勒超声心动图示轻～中度主动脉瓣关闭不全，EBCT三维重建示左肾动脉未见狭窄；2例PTRA术后3年行静脉DSA示扩张的肾动脉管腔仍开通良好。改善3例(30%)，其中1例PTRA术后8年行动脉DSA示双肾动脉管腔无狭窄；1例一侧视力明显减退。无效1例(10%)为PTRA术期间红细胞沉降率轻度升高者。
结论：国人经皮腔内成形术治疗大动脉炎引起的肾血管性高血压可取得较好的远期疗效，大动脉炎活动期不宜行PTRA治疗。
Percutaneous Transluminal Angioplasty for Renovascular Hypertension in Arteritis: Initial Results and 10-Year Follow-up in 10 Patients (Abstract)
, 百拇医药
Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Jiang Shiliang, Huang Lianjun, Jin Jinglin, et al.
Objective: To evaluate long-term efficacy of percutaneous transluminal renal angioplasty (PTRA) for renovascular hypertension in patients with arteritis.
Methods: From March 1983 to Sept. 1988, ten patients with renovascular hypertension caused by Takayasu′s arteritis of the renal arteries were successfully treated with percutaneous transluminal angioplasty. There were 9 females and 1 male with mean age of 24.4 years (ranged from 14 to 35 years). Diagnosis was based on clinical examination such as blood pressure, laboratory examination and digital subtraction angiography (DSA) via either intravenous or intraarterial approaches. Blood pressure ranged from 260/160 mmHg to 150/106 mmHg. One patient had already had contralateral nephrectomy. One patient subsequently underwent contralateral autotransplantation after PTRA on left side. The erythrocyte sedimentation rate (ESR) was normal in 9 patients and mildly elevated in 1. DSA showed unilateral and bilateral artery stenoses in 6 and 4, respectively. Three patients associated with mild abdominal aortic stenosis and 5 patients complicated with single artery lesion of innominate, celiac, superior mesentery, iliac, and pulmonary artery, respectively. The blood pressure was measured before and immediately after the procedure, and also before discharge. All patients were followed with a mean follow-up period of 12.1 years (ranged from 10～15.3 years). Of them, 2 had intravenous DSA (IVDSA) 3 years after PTRA, 1 had intraarterial DSA (IADSA) 8 years after PTRA. Electron beam computed tomography angiography (EBCTA) and three-dimensional reconstruction (3D) were performed in 2 patients 10 years after PTRA. The clinical results of PTRA were evaluated based on the blood pressure response after angioplasty. The patients whose blood pressure was ≤140/90 mmHg without antihypertensive medications were considered cured, those of diastolic pressure decreased <15% or systolic pressure decreased <10% with less antihypertensive medication than before PTRA were considered improved, and those of no change in blood pressure were considered ineffective.
, 百拇医药
Results: The patient′s initial results of PTRA were assessed during hospitalization. Seventy percent (7/10) were cured and 30% (3/10) were improved. Ten-year follow-up results showed that 60% (6/10) were cured. Of those 6, 1 had contralateral nephrectomy 1 year before PTRA, whose ESR was 110 mm/h 10 years after PTRA, but the blood pressure remained normal (140/0～60 mmHg). Echocardiography showed mild to moderate aortic valvular regurgitation, EBCTA and 3D reconstruction showed a fully dilated left renal artery. Further improvement in the lumen diameter on follow-up IVDSA 3 years after angioplasty was noted in 2 patients. Thirty percent (3/10) were improved. Of those 3, 1 had late angiographic restudy 8 years after angioplasty with no evidence of restenosis. One out of ten was ineffective whose ESR was mild elevated during PTRA.
Conclusion: The long-term efficacy of PTRA in patients with arteritis is good. PTRA shouldnot be performed in patients at acute active stage., 百拇医药
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 放射科(100037)
关键词：
中国循环杂志99zk101 目的：评价国人经皮肾动脉腔内成形术(PTRA)治疗大动脉炎所致肾血管性高血压的远期疗效。
方法：1983年3月至1998年9月对10例大动脉炎所致肾血管性高血压患者成功地施行了PTRA，其中男1例，女9例，平均年龄24.4岁(14～35岁)。全部患者均有临床、体检、化验及数字减影造影(DSA)资料。血压范围在260/160 mmHg～150/106 mmHg(1 mmHg=0.133 kPa)。1例PTRA 1年前因右肾动脉重度狭窄行右肾切除术，1例左肾动脉PTRA成功后，右肾施行自体肾移植。红细胞沉降率除1例轻度升高外，余9例均正常。DSA证实单侧及双侧肾动脉狭窄者分别为6例及4例，合并腹主动脉轻度狭窄者3例，合并无名动脉、腹腔动脉、肠系膜上动脉、髂动脉及肺动脉病变者各1例。10例患者于PTRA术前、术后及出院前均测血压。并采用门诊及信访方式进行了随访，平均随访时间12.1年(10～15.3年)。其中2例于PTRA术后3年施行了静脉DSA；1例PTRA术后8年施行了动脉DSA；2例于PTRA术后10年施行了电子束计算机断层摄影术(EBCT)肾动脉三维重建。全部患者均根据临床血压情况来评价PTRA的疗效。未服降压药血压≤140/90 mmHg以下者为治愈；服用降压药量较PTRA术前减少，舒张压较术前下降15%及收缩压较术前下降10%者均为改善；PTRA术后血压无变化者为无效。
, 百拇医药
结果：PTRA术后近期效果：治愈7例(70%)；改善3例(30%)；10年随访结果：治愈6例(60%)，其中1例为右肾切除术1年后又发生左肾动脉狭窄，施行PTRA术后10年红细胞沉降率升高达110 mm/h,但血压仍维持在140/0～60 mmHg,彩色多普勒超声心动图示轻～中度主动脉瓣关闭不全，EBCT三维重建示左肾动脉未见狭窄；2例PTRA术后3年行静脉DSA示扩张的肾动脉管腔仍开通良好。改善3例(30%)，其中1例PTRA术后8年行动脉DSA示双肾动脉管腔无狭窄；1例一侧视力明显减退。无效1例(10%)为PTRA术期间红细胞沉降率轻度升高者。
结论：国人经皮腔内成形术治疗大动脉炎引起的肾血管性高血压可取得较好的远期疗效，大动脉炎活动期不宜行PTRA治疗。
Percutaneous Transluminal Angioplasty for Renovascular Hypertension in Arteritis: Initial Results and 10-Year Follow-up in 10 Patients (Abstract)
, 百拇医药
Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Jiang Shiliang, Huang Lianjun, Jin Jinglin, et al.
Objective: To evaluate long-term efficacy of percutaneous transluminal renal angioplasty (PTRA) for renovascular hypertension in patients with arteritis.
Methods: From March 1983 to Sept. 1988, ten patients with renovascular hypertension caused by Takayasu′s arteritis of the renal arteries were successfully treated with percutaneous transluminal angioplasty. There were 9 females and 1 male with mean age of 24.4 years (ranged from 14 to 35 years). Diagnosis was based on clinical examination such as blood pressure, laboratory examination and digital subtraction angiography (DSA) via either intravenous or intraarterial approaches. Blood pressure ranged from 260/160 mmHg to 150/106 mmHg. One patient had already had contralateral nephrectomy. One patient subsequently underwent contralateral autotransplantation after PTRA on left side. The erythrocyte sedimentation rate (ESR) was normal in 9 patients and mildly elevated in 1. DSA showed unilateral and bilateral artery stenoses in 6 and 4, respectively. Three patients associated with mild abdominal aortic stenosis and 5 patients complicated with single artery lesion of innominate, celiac, superior mesentery, iliac, and pulmonary artery, respectively. The blood pressure was measured before and immediately after the procedure, and also before discharge. All patients were followed with a mean follow-up period of 12.1 years (ranged from 10～15.3 years). Of them, 2 had intravenous DSA (IVDSA) 3 years after PTRA, 1 had intraarterial DSA (IADSA) 8 years after PTRA. Electron beam computed tomography angiography (EBCTA) and three-dimensional reconstruction (3D) were performed in 2 patients 10 years after PTRA. The clinical results of PTRA were evaluated based on the blood pressure response after angioplasty. The patients whose blood pressure was ≤140/90 mmHg without antihypertensive medications were considered cured, those of diastolic pressure decreased <15% or systolic pressure decreased <10% with less antihypertensive medication than before PTRA were considered improved, and those of no change in blood pressure were considered ineffective.
, 百拇医药
Results: The patient′s initial results of PTRA were assessed during hospitalization. Seventy percent (7/10) were cured and 30% (3/10) were improved. Ten-year follow-up results showed that 60% (6/10) were cured. Of those 6, 1 had contralateral nephrectomy 1 year before PTRA, whose ESR was 110 mm/h 10 years after PTRA, but the blood pressure remained normal (140/0～60 mmHg). Echocardiography showed mild to moderate aortic valvular regurgitation, EBCTA and 3D reconstruction showed a fully dilated left renal artery. Further improvement in the lumen diameter on follow-up IVDSA 3 years after angioplasty was noted in 2 patients. Thirty percent (3/10) were improved. Of those 3, 1 had late angiographic restudy 8 years after angioplasty with no evidence of restenosis. One out of ten was ineffective whose ESR was mild elevated during PTRA.
Conclusion: The long-term efficacy of PTRA in patients with arteritis is good. PTRA shouldnot be performed in patients at acute active stage., 百拇医药