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目的探讨早期介入治疗对动脉粥样硬化性肾动脉狭窄合并脑动脉狭窄的疗效和临床意义。方法40例经动脉造影确诊为脑动脉狭窄的患者同时进行肾动脉造影,对其中同时合并肾动脉狭窄和脑动脉狭窄者采取联合介入治疗,并对治疗前后的血压、血脂、尿蛋白、肾功能及用药情况进行比较和分析。结果40例患者中12例为肾动脉狭窄合并脑动脉狭窄(30%)。肾动脉病变血管18条(狭窄比例均≥50%),脑动脉病变血管21条(血管闭塞或狭窄比例≥50%者16条)。对其中的13条肾动脉、14条脑动脉分别进行血管成形术或血管成形术+支架植入术。手术成功率(病变血管开通≥80%):肾动脉狭窄者92%,脑动脉狭窄者87%。6～12个月后血管开通率:肾动脉狭窄者85%,脑动脉狭窄者86%。追踪观察(25±6)个月,83%的患者血压降到140/90mmHg(1mmHg=0.133kPa)以下,患者平均收缩压、舒张压均有不同程度下降;24h尿蛋白定量下降,肌酐清除率上升。降压药由治疗前平均服用3.2种减少到1.3种。均P<0.01或0.05。结论肾动脉狭窄合并脑动脉狭窄进行介入治疗对患者的预后有较大影响。大部分患者高血压可治愈,肾功能得到改善。
Objective To investigate the effect and clinical significance of early interventional therapy on atherosclerotic renal artery stenosis complicated with cerebral artery stenosis. Methods Forty patients with cerebral arterial stenosis who underwent arteriography were enrolled in this study. Renal angiography was performed at the same time. Combined interventional therapy was performed in patients with simultaneous stenosis of renal artery and stenosis of cerebral artery. Blood pressure, blood lipid, urine protein, renal function And medication situation comparison and analysis. Results Of the 40 patients, 12 had renal artery stenosis with cerebral artery stenosis (30%). Renal artery lesions of the vessel 18 (stenosis were ≥ 50%), cerebral artery disease vessels 21 (vascular occlusion or stenosis ≥ 50% of 16). Among them, 13 renal arteries and 14 cerebral arteries were respectively subjected to angioplasty or angioplasty + stent implantation. Surgical success rate (vascular opening ≥ 80%): 92% of renal artery stenosis, 87% of cerebral artery stenosis. Vascular opening rates after 6-12 months: 85% of renal artery stenosis and 86% of cerebral artery stenosis. Follow-up observation (25 ± 6) months showed that the mean systolic blood pressure and diastolic blood pressure of 83% patients decreased to 140/90 mmHg (1mmHg = 0.133kPa) rise. Antihypertensive drugs by taking an average of 3.2 before treatment reduced to 1.3. All P <0.01 or 0.05. Conclusion Interventional treatment of renal artery stenosis with cerebral artery stenosis has a greater impact on the prognosis of patients. Most patients with hypertension can be cured, renal function improved.