王亮,杨胜利,程冠良,刘小慧

• 1:北京大学国际医院心内科
• 2:中国人民解放军总医院第三医学中心

摘要(Abstract)：

本文报道1例患者右肾动脉闭塞后由膈动脉发出的侧支循环供血，肾动脉主干闭塞时间>2周，且患者右肾功能尚满足肾动脉再灌注介入治疗适应证，但是右肾缺血导致显著高肾素血症（超过正常上限10余倍），进而引起顽固性高血压病。经肾动脉介入治疗后血浆肾素水平恢复正常，血压明显降低，血肌酐水平逐渐降低。

关键词(KeyWords)： 肾动脉狭窄;肾动脉闭塞;侧支循环;高肾素血症;高血压病;肾动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王亮,杨胜利,程冠良,刘小慧

参考文献(References)：

• [1]赵佳慧，程庆砾，张晓英.支架重建血运治疗老年粥样硬化性肾动脉狭窄的远期临床结果[J].中华医学杂志，2011,91(24):1673-1676.
• [2]张颖.肾动脉狭窄诊治的研究进展[J].继续医学教育，2010,24(3):64-66.
• [3]凡六章，马根山.动脉粥样硬化性肾动脉狭窄的诊断和介入治疗进展[J].江苏医药，2012,38(8):952-955.
• [4] Ives N,Gray R. The sixth report of the Joint National Committee on prevention,detection,evaluation,and treatment of high blood pressure[J]. Arch Intern Med,1997,157(21):2413-2446.
• [5]李启，王忠民，李在军.多层螺旋CT肾动脉成像在肾动脉狭窄诊断应用价值[J].疾病监测与控制杂志，2011,5(9):577-578.
• [6]徐俊玲，陈传亮，窦社伟，等.流入敏感翻转恢复序列MR血管造影诊断肾动脉狭窄[J].中国医学影像技术，2012,28(6):1221-1225.
• [7]王亮，杨胜利，刘小慧.动脉粥样硬化性肾动脉狭窄的诊疗进展[J].中国介入心脏病学杂志，2018,26(7):407-411.
• [8]洪涛，刘立刚，李建平，等. 1057例肾动脉造影的影像解剖学分析[J].中国介入心脏病学杂志，2006,14(3):155-157.
• [9]覃安琪，马建军，石传楷，等.膈下动脉与左副肾动脉共干起自左肾动脉1例[J].中国临床解剖学杂志，2018,36(2):210.
• [10] Tullis MJ,Caps MT,Zierler RE,et a1. Blood pressure,antihypertensive medication,and atherosclemtic renal artery stenosis[J]. Am J Kidney Dis,1999,33(4):675-681.
• [11] Chobanian AV,Bakris GL,Black HR,et a1. The seventh report of the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure:the JNC 7report[J]. JAMA,2003,289(19):2560-2572.
• [12] Executive summary of the third report of the national cholesterol education program(NCEP)expen panel on detection,evaluation,and treatment of high blood cholesterol in adults(Adult Treatment PanelⅢ)[J]. JAMA,2001,285(19):2486-2497.
• [13] Cooper CJ,Murphy TP,Cutlip DE,et a1. Stenting and medical therapy for atheroselerotic renal-artery stenosis[J]. N Engl J Med,2014,370(1):13-22.
• [14]汤曾耀，郑泽琪，梅寒颖，等.动脉粥样硬化性肾动脉狭窄介入治疗与药物治疗的临床分析[J].检验医学与临床，2013,10(22):2939-2942.
• [15] Tendera M,Aboyans V,Bartelink ML,et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases:document covering atherosclerotic disease of extracranial carotid and vertebral,mesenteric,renal,upper and lower extremity arteties:the task force on the diagnosis and treatment of peripheral artery diseases of the european society of cardiology(ESC)[J]. Eur Heart J,2011,32(22):2851-2906.
• [16] Kumbhaui DJ,Barry AA,Harvey JE,et a1. Clinical outcomes after percutaneous revaseularization versus medical management in patients with signifi cant renal artery stenosis:a meta-analysis of randomized controlled trials[J]. Am Heart J,2011,161(3):622-630.
• [17] Marcantoni C,Zanoli L,Rastelli S,et a1. Ef fect of renal artery stenting on left ventfi cular mass:a randomized clinical trial[J].Am J Kidney Dis,2012,60(1):39-46.
• [18] Bax L,Woittiez AJ,Kouwenberg HJ,et al. Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function:a randomized trial[J]. Ann Intern Med,2009,150(12):840-848.
• [19] Wheatley K,Ives N,Gray R,et al. Revascularization versus medical therapy for renal-artery stenosis[J]. N Engl J Med,2009,361(20):1953-1962.
• [20] Dorms G,Jaff M,Mathiak L,et a1. Four-year followup of Palmaz-Schatz stent revaseularization as treatment for atherosclerotie renal artery stenosis[J]. Circulation,1998,98(7):642-647.
• [21] Ritchie J,Green D,Chrysochou C,et a1. High-risk clinical presentations in atherosclerotic renovascular disease:prognosis and response to renal artery revascularization[J]. Am J Kidney Dis,2014,63(2):86-97.
• [22] Parikh SA,Shishehbor MH,Gray BH,et al. SCAI expert consensus statement for renal artery stenting appropriate use[J].Catheter Cardiovasc Interv,2014,84(7):1163-1171.
• [23]林云华，王俊生，姜永光，等.急性肾梗死的早期诊断和介入治疗[J].中华泌尿外科杂志，2012,33(11):851-855.