Lekston Andrzej, Chudek Jerzy, Gasior Mariusz, Wilczek Krzysztof, Wiecek Andrzej, Kokot Franciszek, Szyguła-Jurkiewicz Bozena, Wojnicz Romuald, Osuch Marcin, Poloński Lech
Silesian Centre for Heart Diseases, Zabrze, Poland.
Kardiol Pol. 2008 Oct;66(10):1061-6; discussion 1067-8.
Renal ischaemia resulting from stenosis of the renal artery may result in two important sequelae: systemic arterial hypertension, and renal atrophy and nephron loss, resulting in an increased risk of progression to end-stage renal disease. Renal artery stenosis (RAS) may lead to both renovascular hypertension and ischaemic nephropathy - a potentially curable cause of renal failure.
To assess the efficacy of g-intraluminal brachytherapy (ILBT) in prevention of restenosis after percutaneous transluminal renal artery angioplasty (PTRA) and the effects of this method of revascularisation on renal function.
71 patients aged 52+/-8 years with refractory renovascular hypertension were randomised to group I (PTRA + ILBT) or group II (PTRA). Both baseline and 9-month follow-up angiography, intra-vascular ultrasound and non-invasive examination were performed to assess the efficacy of PTRA on renal function.
The overall PTRA success rate was 87%: 33 patients from group I and 29 from group II underwent a successful procedure. A decrease of serum creatinine level was observed regardless of the treatment modality, directly after angioplasty: 20 micromol/l (17.5%) in group I and 26 micromol/l (22%) in group II (NS). Also in long-term follow-up this effect was sustained: 18 micromol/l (15.8%) in group I and 10 micromol/l (8.5%) in group II (NS). In the follow-up period a non-significant increase of serum creatinine level was observed in group I (from 94+/-19 to 96+/-25 micromol/l, NS). In group II the increase of serum creatinine level was significantly higher (from 92+/-39 micromol/l to 108+/-60 micromol/l, p=0.001).
PTRA improves renal function in patients with ischaemic nephropathy. In long-term observation the positive effect of PTRA on renal function is especially visible in patients with ILBT after PTRA.
肾动脉狭窄导致的肾缺血可能会引发两个重要后果：全身性动脉高血压以及肾萎缩和肾单位丧失，进而增加发展为终末期肾病的风险。肾动脉狭窄（RAS）可能导致肾血管性高血压和缺血性肾病——一种潜在可治愈的肾衰竭病因。
评估γ腔内近距离放射治疗（ILBT）在预防经皮腔内肾动脉成形术（PTRA）后再狭窄方面的疗效，以及这种血管重建方法对肾功能的影响。
将71例年龄为52±8岁的难治性肾血管性高血压患者随机分为I组（PTRA + ILBT）或II组（PTRA）。在基线期以及9个月随访时均进行血管造影、血管内超声检查和非侵入性检查，以评估PTRA对肾功能的疗效。
PTRA的总体成功率为87%：I组33例患者和II组29例患者手术成功。无论治疗方式如何，血管成形术后即刻均观察到血清肌酐水平下降：I组下降20微摩尔/升（17.5%），II组下降26微摩尔/升（22%）（无显著性差异）。在长期随访中这种效果得以持续：I组下降18微摩尔/升（15.8%），II组下降10微摩尔/升（8.5%）（无显著性差异）。在随访期间，I组血清肌酐水平出现无显著性升高（从94±19微摩尔/升升至96±25微摩尔/升，无显著性差异）。II组血清肌酐水平升高更为显著（从92±39微摩尔/升升至108±60微摩尔/升，p = 0.001）。
PTRA可改善缺血性肾病患者的肾功能。在长期观察中，PTRA对肾功能的积极作用在PTRA联合ILBT的患者中尤为明显。
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