动脉粥样硬化性肾动脉狭窄临床特点分析及诊断方法比较

摘要

目的 分析动脉粥样硬化性肾动脉狭窄(ARAS)的临床特征及探讨经肾动脉超声和计算机断层扫描造影(CTA)诊断ARAS的准确性.方法 纳入2005年1月～2010年10月解放军总医院住院患者中经肾动脉造影确诊为ARAS患者179例(肾动脉狭窄＞50%),对其临床表现进行回顾性分析,并比较肾动脉超声及肾动脉CT造影(CTA)与肾动脉造影结果的差异.结果 179例ARAS患者中,有74例(41.34%)表现为难以控制的高血压,96例(53.63%)伴胸痛,6例(3.35%)出现急性肺水肿,102例(57%)伴肾损害.其中124例ARAS患者同时进行了肾动脉超声检查,结果显示肾血流速度＞171cm/s时有最大受试者工作特征曲线(ROC)下面积,此时肾动脉超声的敏感性和特异性分别为86%和75%;另有23例(46支血管)同时进行了肾动脉CTA检查,肾动脉CTA显示的狭窄血管数多于肾动脉造影[32支(69.6%) vs.26支(56.5%)],但无统计学差异(P=0.082).结论 ARAS临床表现多样,其中又以肾损伤、胸痛和高血压最为常见,肾动脉超声诊断ARAS的灵敏度和特异性均较高,而肾动脉CTA较肾动脉造影存在过度诊断的倾向.%Objective To analyze Clinical characteristics of atherosclerotic renal artery stenosis ( ARAS ) and the diagnostic accuracy of renal artery ultrasound examination and renal artery computed tomography angiography ( CTA ) . Methods The patients (n=179 ) with ARAS diagnosed by renal artery CTA ( renal artery stenosis>50% ) were chosen from Fan. 2005 to Oct. 2010. The clinical symptoms were analyzed retrospectively, and the difference between renal artery ultrasound examination or renal artery CTA and renal artery angiography was compared. Results Among 179 patients, 74 ( 41.34% ) with unmanageable hypertension, 96 ( 53.63% ) with chest pain, 6 ( 3.35% ) with acute pulmonary edema and 102 ( 57% ) with renal lesion. After the renal artery ultrasound examination in 124 patients, the results showed that when kidney blood flow velocity was over 171 cm/s, the area under receiver operating characteristic ( ROC ) curve reached the maximum, and the sensitivity and specificity of renal artery ultrasound examination was respectively 86% and 75%. At the same time, 23 cases (46 vessels ) were given renal artery CTA and the results showed that stenosis vessels by CTA were more than those by renal artery angiography [32 ( 69.6% ) vs. 26 ( 56.5% ) ] but the difference was no significant ( P=0.082 ) . Conclusion Renal artery ultrasound examination can reach the highest sensitivity and specificity when kidney blood flow velocity equals to 171 cm/s and is taken as the diagnostic threshold of ARAS, while renal artery CTA has a trend of over-diagnosis compared with renal artery angiography.