关键词: 动脉狭窄, 肾移植, 经皮腔内血管成形术

Abstract:

ABSTRACTS OBJECTIVE: To investigate the diagnostic characteristic of transplant renal artery stenosis and the curative effects of PTA. Methodology: All the changing characteristics of renal function, blood pressure, nephritic color, artery CTA as well as DSA on transplant renal patients who got their final diagnosis of TRAS was recorded. A self-controlled study was conducted to analyze the changes of clinical factors after PTA treatment, in which the curative effects of PTA can be judged. Results: Seventeen patients were diagnosed with TRAS in our center, incidence rate of which was high to 1.34%. These people were also diagnosed with high Scr or low eGFR at various degree, whose Scr increased to（194.8±80.0）ummol/L （p<0.01）compared with the normal level of（143.1±53.7）ummol/L, and eGFR decreased to（36.9±10.4）ml/min（p<0.01）with（52.3±15.6）ml/min（p<0.01）. 58.8% of the patients had higher MAP, which increased from （97.0±8.7）mmHg to （108.7±14.4）mmHg（p<0.01）. Color ultrasonography also revealed that these patients had faster renal peak systolic velocity (RPSV), which increased from 125.9±22.9 cm/s to 331.8±132.7 cm/s（p<0.01）. 82.4% of the patients had lower RI of the renal artery stenosis restriction, which decreased from 0.75±0.07 to 0.61±0.17（p=0.001）. In contrast, there were no significant changes in the flow rate and RI of the interlobular artery. 17 patients were all revealed of artery stenosis after CTA test which followed after color ultrasonography. The degree of artery stenosis was evaluated to be 70%-90% through DSA examination. All patients were treated by PTA. Among them, 13 were found with improved renal function and the effective rate was as high as 76.5%. Vesting period was between 7-27 days (an average of 14.5±4.8）. The other 4 cases were found with the same before or even damaged renal function. After being treated by PTA, their Scr was converted down to 153.0±43.0 ummol/L, eGFR up to 47.9±16.1 ml/min, MAP down to 93.4±7.2 mmHg, flow rate of artery stenosis restriction down to 156.3±58.0 cm/s, together with RI in artery stenosis restriction up to 0.74±0.08. All indexes above improved compared with those when the patients had artery stenosis, with statistical significance（p<0.05）. Appositively, except for MAP, of which p=0.005, the other indexes above indicated no significant difference compared with those before artery stenosis(p>0.05）. Conclusion: 1. TRAS patients are finally diagnosed with damaged renal function or abnormal arteries hemodynamics revealed by color ultrasonography. 2. PTA should be the top choice for TRAS. Vesting period on average is 14 days, with perfect clinical effects.

Key words: renal transplant,  artery stenosis,  PTA