双侧肾动脉狭窄致难治性高血压1例并文献复习

李文涛; 刘川; 相彤; 曹若瑾; 吴浩

doi:10.16766/j.cnki.issn.1674-4152.003571

双侧肾动脉狭窄致难治性高血压1例并文献复习

doi: 10.16766/j.cnki.issn.1674-4152.003571

李文涛¹,
刘川²,
相彤¹,
曹若瑾²,
吴浩^1, ,

1.
首都医科大学全科医学与继续教育学院，北京 100069
2.
首都医科大学宣武医院全科医学科，北京 100053

基金项目:

北京市卫生系统高层次卫生技术人才队伍建设项目 2022-1-005

首都卫生发展科研专项项目首2022-2-7052

详细信息

通讯作者:
吴浩，E-mail：wushunzhe@ccmu.edu.cn

中图分类号: R544.14 R692.16
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- 文章访问数: 385
- HTML全文浏览量: 150
- PDF下载量: 17
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-21
- 网络出版日期: 2024-07-22

Refractory hypertension caused by bilateral renal artery stenosis: a case report and literature review

1.
School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China

摘要

摘要: 由双侧肾动脉狭窄(RAS)所致的难治性高血压，发病率较低，临床诊治较为困难。首都医科大学宣武医院全科医学科收治1例48岁男性患者，近期出现严重的高血压病史。考虑患者的年龄及高血压的严重程度，笔者筛查了继发性高血压的常见原因，进一步行腹主动脉CT血管成像，提示双侧肾动脉开口处中-重度狭窄，为双侧肾动脉狭窄导致的难治性高血压。联合血管外科分期实施双侧肾动脉支架植入术，术后随访患者血压逐渐控制稳定。本文对该患者具体诊治经过进行回顾性分析，并复习相关文献。
- 难治性高血压 /
- 双侧肾动脉狭窄
Abstract: Refractory hypertension caused by bilateral renal artery stenosis (RAS) has a low incidence and is difficult to diagnose and treat clinically. The Department of General Medicine of Xuanwu Hospital Capital Medical University admitted a 48-year-old male patient with a recent history of severe hypertension. Considering the patient's age and severity of hypertension, we screened for common causes of secondary hypertension. Further abdominal aortic CTangiography showed moderate to severe stenosis at the openings of the bilateral renal arteries, which led to refractory hypertension. Therefore, angioplasty of both renal arteries was performed as a staged procedure, and the patient's blood pressure was gradually controlled and stabilized during postoperative follow-up. This article reviews the specific diagnosis and treatment process and reviews relevant literature.
- Refractory hypertension /
- Bilateral renal artery stenosis

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图 1 腹主动脉CTA

Figure 1. Abdominal Aortic CTA

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图 2 支架植入术前

Figure 2. Before stent implantation

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图 3 支架植入术后

Figure 3. After stent implantation

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表 1 患者肾素-醛固酮检测动态试验情况

Table 1. Dynamic test of renin aldosterone detection in patients

项目	8点 (服药)	9点	10点	11点	术后1个月
醛固酮(pg/mL)	108.55	182.99	147.97	180.89	-
肾素(uIU/mL)	284.71	562.31	4 436.01	4 798.98	29.33
醛固酮/肾素	0.38	0.33	0.03	0.04	-
注：“-”为未查该项目。

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表 2 SCAI、AHA/ACC、ESC指南关于RAS患者治疗建议

Table 2. Recommendations for Stenting Treatment of RAS Patients in SCAI, AHA/ACC, and ESC Guidelines

临床表现	SCAI	AHA/ACC建议		ESC
临床表现	SCAI	推荐等级	证据水平	推荐等级	证据水平
难治性高血压(联用三种降压药物至最大剂量控制不佳，包括使用利尿剂)双侧或单功能肾重度RAS	适用	Ⅱa	B	Ⅲ	A
难治性高血压(联用三种降压药物至最大剂量控制不佳，包括使用利尿剂)单侧重度RAS	可能适用	Ⅱa	B	Ⅲ	A
无症状、单侧、双侧或单功能肾，血流动力学显著的RAS	可能适用	Ⅱa	B	Ⅲ	A
注：SCAI为美国心血管造影与介入学会；ACC为美国心脏病学会；AHA为美国心脏病学会；ESC为欧洲心脏病学会；RAS为肾动脉狭窄。Ⅱa级推荐为存在相互矛盾的证据和/或意见分歧，但大量证据证明有效；Ⅲ级推荐为有证据表明该治疗无效或某些情况下有害，不推荐。A级为对随机临床试验的系统回顾或荟萃分析；B级为随机或非随机的临床试验。

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参考文献(16)

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