同种异体肾移植术后早期肾动脉狭窄诊疗的回顾性研究

摘要

目的 通过单中心移植肾动脉狭窄(TRAS)诊疗的回顾性研究,探讨早期诊断及治疗移植肾动脉狭窄的方法.方法 统计本中心同种异体肾移植术后287例患者的临床表现、检验数据及影像学资料,比较TRAS患者与非TRAS患者移植肾超声参数,建立筛查TRAS的超声诊断阈值.比较有症状TRAS患者和无症状TRAS患者介入治疗前后肌酐、血压的变化.结果 287例患者中共出现13例TRAS患者.移植肾动脉收缩期峰值流速(PSV)＞ 250 cm/s、叶间动脉动脉阻力指数(RI)＜0.51、移植肾动脉与叶间动脉PSV比值＞10可以作为筛查TRAS的超声阈值.有症状TRAS患者与无症状TRAS患者经血管腔内血管成形术(PTA)治疗后肌酐、平均动脉压均显著下降(P＜0.05).结论 在肾移植术后定期随访中监测肾移植血流量和临床表现有助于早期诊断TRAS.移植肾动脉PSV＞ 250 cm/s、叶间动脉RI ＜0.51、移植肾动脉与叶间动脉PSV比值＞10可以作为筛查TRAS的超声阈值.%Objective To explore the early diagnosis and treatment for transplant renal artery stenosis (TRAS) through single-center retrospective study.Methods Clinical manifestation,laboratory tests and imaging data in 287 patients underwent renal transplantation in our center were analyzed retrospectively.Ultrasound parameters in TRAS patients and non-TRAS patients was compared to discover the thresholds of some CDUS parameters.Changes of ultrasound parameter and serum creatinine in TRAS patients and non-TRAS patients were compared.The changes of blood pressure and serum creatinine before and after percutaneous transluminal angioplasty (PTA) were observed.Results Totally 13 cases had TRAS in the 287 patients.Renal artery PSV ＞ 250 cm/s,interlobar artery resistance index (RI) ＜0.51,PSV ratio of the renal artery to the interlobar artery ＞ 10 were considered as the color doppler ultrasound (CDUS) diagnostic threshold.Symptomatic TRAS patients and asymptomatic TRAS patients were treated by PTA,and the serum creatinine and mean arterial pressure significantly decreased (P ＜ 0.05).Conclusion Monitoring renal allograft blood flow and clinical manifestation after renal transplantation is helpful for early diagnosis of TRAS in the postoperatively follow-up.Transplant renal artery PSV ＞ 250 cm/s,interlobar artery RI ＜ 0.51 and PSV ratio of the renal artery to the interlobar artery ＞ 10 can be considered as the CDUS diagnostic threshold.