CAJ | 학술논문

目的探讨99Tcm-DTPA肾动态显像评价和预测经皮腔内肾动脉支架置人术(PTRAS)治疗动脉粥样硬化性肾动脉狭窄(ARAS)的疗效.方法成功接受PTRAS治疗的单侧ARAS患者76例,分别于术前2周内和术后6个月进行99Tcm-DTPA肾动态显像,利用Gates法测定患侧GFR.根据肾动脉造影结果将狭窄程度分为轻度(50％～69％)、中度(70％～89％)、重度(≥90％)狭窄;根据术前GFR测定结果将患肾功能分为Ⅰ级(GFR≥30 ml/min)、Ⅱ级(15 ml/min≤GFR＜ 30 ml/min)和Ⅲ级(GFR＜ 15 ml/min).通过对比患者术前与术后6个月肾GFR与血压变化情况对PTRAS进行疗效判定.采用SPSS 13.0软件对数据分别进行t检验、x2检验、Fisher精确概率法检验和多元logistic回归分析.结果术前重度狭窄患者患肾GFR低于轻中度狭窄患者[(19.48±11.56)ml/min与(26.79±15.34) ml/min,t =2.262,P=0.027].PTRAS术后血压改善者占32％( 24/75),无变化者占68％(51/75).术前患肾功能为Ⅰ、Ⅱ级患者术后高血压改善率为39.62％( 21/53),高于肾功能为Ⅲ级患者的13.64％ (3/22),x2=4.825,P=0.028;多因素分析示术前患肾功能分级是影响患者术后血压改善的惟一因素(OR=0.465,P=0.032).PTRAS术后GFR改善者占22.37％ (17/76),无变化者占68.42％ (52/76),降低者占9.21％ (7/76);在血压改善组与未改善组患者中,GFR改善的比率分别为33.33％ (8/24)和17.65％ (9/51),但差异无统计学意义(Fisher精确概率检验,P=0.081).结论肾动态显像可以客观评价单侧ARAS患者PTRAS术后患肾GFR变化,并可预测术后血压改善情况.
목적 탐토99Tcm-DTPA신동태현상평개화예측경피강내신동맥지가치인술(PTRAS)치료동맥죽양경화성신동맥협착(ARAS)적료효.방법 성공접수PTRAS치료적단측ARAS환자76례,분별우술전2주내화술후6개월진행99Tcm-DTPA신동태현상,이용Gates법측정환측GFR.근거신동맥조영결과장협착정도분위경도(50％～69％)、중도(70％～89％)、중도(≥90％)협착;근거술전GFR측정결과장환신공능분위Ⅰ급(GFR≥30 ml/min)、Ⅱ급(15 ml/min≤GFR＜ 30 ml/min)화Ⅲ급(GFR＜ 15 ml/min).통과대비환자술전여술후6개월신GFR여혈압변화정황대PTRAS진행료효판정.채용SPSS 13.0연건대수거분별진행t검험、x2검험、Fisher정학개솔법검험화다원logistic회귀분석.결과 술전중도협착환자환신GFR저우경중도협착환자[(19.48±11.56)ml/min여(26.79±15.34) ml/min,t =2.262,P=0.027].PTRAS술후혈압개선자점32％( 24/75),무변화자점68％(51/75).술전환신공능위Ⅰ、Ⅱ급환자술후고혈압개선솔위39.62％( 21/53),고우신공능위Ⅲ급환자적13.64％ (3/22),x2=4.825,P=0.028;다인소분석시술전환신공능분급시영향환자술후혈압개선적유일인소(OR=0.465,P=0.032).PTRAS술후GFR개선자점22.37％ (17/76),무변화자점68.42％ (52/76),강저자점9.21％ (7/76);재혈압개선조여미개선조환자중,GFR개선적비솔분별위33.33％ (8/24)화17.65％ (9/51),단차이무통계학의의(Fisher정학개솔검험,P=0.081).결론 신동태현상가이객관평개단측ARAS환자PTRAS술후환신GFR변화,병가예측술후혈압개선정황.
Objective To investigate the value of renal dynamic imaging with 99Tcm-DTPA on the evaluation and prediction of the outcome after percutaneous transluminal renal artery angioplasty and stenting (PTRAS) in patients with atherosclerotic renal artery stenosis (ARAS).Methods Seventy-six patients with unilateral ARAS underwent PTRAS successfully.All the patients received baseline renal dynamic imaging within 2 weeks before the surgery and follow-up imaging 6 months after PTRAS.GFR ( per 1.73 m2 of body surface area) of kidney with ARAS was measured with the Gates method.ARAS was classified as mild (50％-69％),moderate (70％-89％),and severe ( ≥90％ ) stenosis according to the results of renoarteriography before the surgery.GFR was graded as Ⅰ ( GFR≥30 ml · min -1 ),Ⅱ ( 15 ml · min -1 ≤GFR ＜30 ml · min -1 ) and Ⅲ ( GFR ＜ 15 ml · min-1 ),on the baseline dynamic imaging.Blood pressure was also measured before and after the surgery.The t test,x2 test,Fisher exact test and multiple logistic regression analysis were used for statistical analysis with SPSS 13.0.Results The baseline GFR of kidney with mild and moderate ARAS was significant higher than that with severe stenosis ( (26.79 ± 15.34) vs ( 19.48 ±11.56) ml · min - 1,t =2.262,P =0.027 ).The blood pressure was improved in 32％ (24/75),and not changed in 68％ (51/75) of patients.Improvement of blood pressure was observed in 39.62％ (21/53) of patients with a baseline GFR≥ 15 ml · min-1,and in 13.64％ (3/22) of patients with a baseline GFR ＜15 ml · min - 1 (x2 =4.825,P =0.028 ).Using multivariate analysis,baseline GFR ≥ 15 ml · min - 1 was the only predictor of blood pressure improvement ( OR =0.465,P =0.032 ).GFR in kidney with ARAS was improved in 22.37％ ( 17/76),stable in 68.42％ (52/76),and worse in 9.21％ (7/76) of patients.The 33.33％ (8/24) and 17.65％ (9/51) of patients with and without blood pressure improvement,respectively,achieved GFR improvement.However,the difference was not statistically significant ( Fisher exact test,P =0.081 ).Conclusion Renal dynamic imaging with 99Tcm-DTPA is a useful method for the evaluation and prediction of the therapeutic effect of PTRAS in patients with ARAS.