Günay Emel Ceylan, Oztürk M Halil, Ergün Eser Lay, Altun Bülent, Salanci Bilge Volkan, Uğur Omer, Cil Barbaros, Hekimoğlu Baki, Caner Biray
Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Eur J Nucl Med Mol Imaging. 2005 Sep;32(9):1064-74. doi: 10.1007/s00259-005-1789-9. Epub 2005 May 5.
Radionuclide renography with angiotensin converting enzyme (ACE) inhibition plays an important role in the diagnosis of haemodynamically significant renal artery stenosis. Angiotensin receptor antagonists inhibit the renin angiotensin system at different levels from ACE inhibitors by selectively blocking the binding of angiotensin II to AT1 receptors. The AT1 angiotensin receptor antagonist losartan has recently been used clinically in the treatment of hypertension. However, the available data on the use of losartan with renography for the detection of renovascular hypertension are limited and contradictory. The purpose of this prospective study was to compare the effectiveness of losartan renography and captopril scintigraphy in revealing renal artery stenosis.
A total of 61 renal units in 32 patients with hypertension were studied in two groups based on the losartan dosage (50 mg in group A and 100 mg in group B). Group A consisted of 17 patients, in whom 19 renal units had angiographically proven renal artery stenosis (>or=50%). In group B, there were 15 patients, in whom 20 renal arteries were stenotic. All of the patients underwent three renographies (baseline, captopril renography and early losartan renography). Early losartan renography was performed at 1 h after oral losartan administration in both groups. In group B, seven patients underwent additional losartan renography (late losartan) performed 3 h after oral losartan administration; these patients composed group B1.
The sensitivities of captopril and losartan studies were 63.2% and 42% in group A, 65% and 65% in group B and 55.6% and 66.6% in group B1, respectively.
From our preliminary results, we conclude that losartan is not superior to captopril renography for the detection of haemodynamically significant renal artery stenosis. However, a high dose (100 mg) of losartan provided higher sensitivity than the lower dose (50 mg). Late losartan scintigraphy provided similar diagnostic efficacy to early losartan renography.
血管紧张素转换酶（ACE）抑制放射性核素肾图在血流动力学显著的肾动脉狭窄诊断中起重要作用。血管紧张素受体拮抗剂通过选择性阻断血管紧张素II与AT1受体的结合，在不同于ACE抑制剂的水平上抑制肾素血管紧张素系统。AT1血管紧张素受体拮抗剂氯沙坦最近已临床用于治疗高血压。然而，关于氯沙坦与肾图用于检测肾血管性高血压的现有数据有限且相互矛盾。这项前瞻性研究的目的是比较氯沙坦肾图和卡托普利闪烁扫描在揭示肾动脉狭窄方面的有效性。
基于氯沙坦剂量（A组50mg，B组100mg）将32例高血压患者的61个肾单位分为两组进行研究。A组由17例患者组成，其中19个肾单位经血管造影证实有肾动脉狭窄（≥50%）。B组有15例患者，其中20条肾动脉狭窄。所有患者均接受三次肾图检查（基线、卡托普利肾图和早期氯沙坦肾图）。两组均在口服氯沙坦后1小时进行早期氯沙坦肾图检查。在B组中，7例患者在口服氯沙坦后3小时进行了额外的氯沙坦肾图检查（晚期氯沙坦）；这些患者组成B1组。
A组中卡托普利和氯沙坦研究的敏感性分别为63.2%和42%，B组为65%和65%，B1组为55.6%和66.6%。
从我们的初步结果来看，我们得出结论，在检测血流动力学显著的肾动脉狭窄方面，氯沙坦并不优于卡托普利肾图。然而，高剂量（100mg）氯沙坦比低剂量（50mg）具有更高的敏感性。晚期氯沙坦闪烁扫描与早期氯沙坦肾图具有相似的诊断效果。
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