摘要
目的探讨经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗儿童肾动脉狭窄导致的肾血管性高血压(renovascular hypertension RVH)的疗效及临床疗效相关因素分析。方法回顾性分析2017年1月至2023年7月广州市妇女儿童医疗中心应用PTA治疗儿童RVH的临床资料,共纳入患儿31例,其中包括肌纤维发育不良(fibromuscular dysplasia,FMD)19例,多发性大动脉炎(takayasu arteritis,TA)12例。通过对手术前后体征、血压等指标进行比较,评价治疗疗效及相关因素。结果共行PTA 48次,随访时间为0.5~6.6年,其中治愈患儿共17例,症状改善患儿7例。PTA治疗后长期获益者24例(77.4%),其中FMD患儿长期获益者16例,TA患儿8例;根据治疗效果分组,与治疗有效组患儿比较,无效组患儿中基础收缩压较高(181 mmHg vs 155 mmHg),血管非局灶性病变比例较高(85.7%vs 16.7%),合并其他症状比例较高(100.00%vs 0.00%),差异均有统计学意义(P<0.05)。单因素和多因素回归分析均发现肾动脉局灶病变是PTA治疗效果的保护因素,局灶病变患儿手术有效率是非局灶性病变患儿的30倍(OR=30,P=0.005)。结论经皮腔内血管成形术治疗儿童RVH是安全有效的,且长期随访结果良好。肾动脉局灶病变患儿术后疗效相对较好。
Objective To investigate the percutaneous transluminal angioplasty(PTA)Safety,efficacy,and clinical efficacy related factor analysis of renal vascular hypertension(RVH)caused by renal artery stenosis in children.Methods The clinical data from January 2017 to July 2023,a total of 31 cases were included,including 19 cases of Fibromuscular dysplasia(FMD)and 12 cases of Takayasu arteritis(TA).The treatment efficacy and related factors were evaluated by comparing the signs and blood pressure before and after surgery.Results A total of 48 PTA sessions were performed,and the follow-up time was from 0.5 to 6.6 years,among which 17 patients were cured,and 7 patients had improved symptoms.24 patients(77.4%)after percutaneous angioplasty,including 16 children with long-term benefit with FMD and 8 children with TA;the ineffective patients had high basal systolic pressure(155 mmHg vs 181 mmHg)and high proportion of vascular non-focal lesions(85.7%vs 16.7%);moreover,all ineffective patients with other symptoms(100%),and the differences were statistically significant.Both univariate and multivariate regression analysis found that focal renal artery lesions were a protective factor for the effect of PTA treatment,and the surgical response rate in patients with focal lesions was 30 times that in patients with non-focal lesions(OR=30,P=0.005).Conclusion Percutaneous transluminal angioplasty is safe and effective with good long-term follow-up.Patients with focal renal artery lesions had relatively good results after surgery.
作者
庞宁东
蒋贻洲
姜华
牛传强
李海波
刘浪
刘珍银
张靖
Pang Ningdong;Jiang Yizhou;Jiang Hua;Niu Chuanqiang;Li Haibo;Liu Lang;Liu Zhenyin;Zhang Jing(Department of Interventional Radiology&Vascular Anomalies,Guangzhou Women and Children's Medical Center,Guangdong Guangzhou 510627;Department of Minimally Invasive Intervention,Guangdong Academy of Medical Sciences,Guangdong Provincial People's Hospital,Guangdong Guangzhou 510627,China)
出处
《中华介入放射学电子杂志》
2024年第1期22-26,共5页
Chinese Journal of Interventional Radiology：electronic edition
基金
广州市科技计划项目(202102020227)。
关键词
经皮腔内血管成形术
儿童
高血压
肾动脉狭窄
疗效
Percutaneous transluminal angioplasty
Children
Hypertension
Renal artery stenosis
Efficacy
