Miralles M, Covas M I, Martínez Miralles E, Cairols M, Cotillas J, Santiso M A
Departamento de Cirugía, Hospital Universitario del Mar (Universidad Autónoma de Barcelona), Spain.
Am J Hypertens. 1997 Nov;10(11):1290-6. doi: 10.1016/s0895-7061(97)00280-x.
To evaluate the utility of renal duplex scanning and the captopril test in the detection and functional assessment of renovascular disease, by comparing their results with those of angiography and captopril isotopic renography (CIR). Sixty hypertensive patients with aortoiliac disease and 16 with clinically suspected renovascular hypertension (RVH) were included. All the patients underwent renal duplex scanning prior to angiography. In addition, isotopic renograms and a determination of peripheral plasma renin activity (PRA) at baseline and 60 min after oral intake of 50 mg of captopril were both performed. A postcaptopril PRA > 5.7 ng/mL/h was considered as diagnostic of a positive captopril test. On the basis of the results of the angiography and isotopic renograms, all the patients were classified into three groups: group I (n = 33), essential hypertension (EHT); group II (n = 20), hypertension and angiographic RAS > 60% but negative CIR; and group III (n = 24), RAS > 60% and positive CIR. This last condition was considered as highly suspicious for RVH. Renal duplex scanning showed greater accuracy than captopril PRA or CIR for detecting RAS > 60% (groups II and III) with 87.3% versus 52.4% and 45.3% sensitivity (S), and 91.5% versus 84.4% and 92.8% specificity (Sp), respectively. The captopril test correctly identified 44 of 51 EHT patients (groups I and II) and 20 of 23 highly suspected of RVH (group III) with 87% S, 86.5% Sp, 74.1% PPV, and 93.6% NPV. Accuracy was further increased when a combined approach (renal duplex scanning and captopril test) was followed (82.6% S, 93.7% Sp, 86.4 PPV, and 91.8 NPV). In our study, renal duplex scanning was a useful screening method for detecting anatomical RAS. A combination of both renal duplex scanning and captopril test may be an appropriate approach to the primary screening for RVH, thereby permitting the selection of those patients indicated for angiography.
通过将肾双功扫描和卡托普利试验的结果与血管造影和卡托普利同位素肾图（CIR）的结果进行比较，以评估肾双功扫描和卡托普利试验在肾血管疾病检测和功能评估中的效用。纳入了60例患有主髂动脉疾病的高血压患者和16例临床疑似肾血管性高血压（RVH）的患者。所有患者在血管造影前均接受肾双功扫描。此外，还进行了同位素肾图检查，并在基线以及口服50mg卡托普利后60分钟测定外周血浆肾素活性（PRA）。卡托普利试验后PRA>5.7ng/mL/h被视为诊断阳性。根据血管造影和同位素肾图的结果，所有患者被分为三组：第一组（n = 33），原发性高血压（EHT）；第二组（n = 20），高血压且血管造影显示肾动脉狭窄（RAS）>60%但CIR阴性；第三组（n = 24），RAS>60%且CIR阳性。最后这种情况被认为高度怀疑为RVH。在检测RAS>60%（第二组和第三组）方面，肾双功扫描显示出比卡托普利PRA或CIR更高的准确性，敏感性（S）分别为87.3%、52.4%和45.3%，特异性（Sp）分别为91.5%、84.4%和92.8%。卡托普利试验正确识别出51例EHT患者（第一组和第二组）中的44例以及23例高度怀疑为RVH的患者（第三组）中的20例，S为87%，Sp为86.5%，阳性预测值（PPV）为74.1%，阴性预测值（NPV）为93.6%。当采用联合方法（肾双功扫描和卡托普利试验）时，准确性进一步提高（S为82.6%，Sp为93.7%，PPV为86.4，NPV为91.8）。在我们的研究中，肾双功扫描是检测解剖学RAS的一种有用的筛查方法。肾双功扫描和卡托普利试验相结合可能是RVH初步筛查的合适方法，从而可以选择那些适合进行血管造影的患者。
