卡托普利介入99mTc-双半胱氨酸肾动态显像对肾血管性高血压患者的价值
Value of captopril intervened 99mTc-ethylenedicysteine renal dynamic imaging in renovascular hypertension patients
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摘要: 目的 研究卡托普利介入99mTc-双半胱氨酸(99mTc-EC)肾动态显像对高血压患者的肾血管性原因的诊断准确性,并评价其对肾血管性高血压(RVH)患者血管成型术后肾功能改善的预测价值。方法 55例临床疑似RVH的患者,口服卡托普利50mg,60min后进行99mTc-EC肾动态显像,结果异常患者次日再进行基线水平肾动态显像。按照显像结果将RVH的诊断分为高度可能组、不确定组和低度可能组。结果 高度可能组的22例患者中20例有肾动脉狭窄(RAS);不确定组10例中的5例有RAS;低度可能组23例均证实没有RAS。如果将不确定诊断组和低度可能组归为阴性,诊断RAS的灵敏度为80%,特异度为93.3%,阳性预测值为90.9%,阴性预测值为84.8%;如果将高度可能组和不确定诊断组归为阳性,则灵敏度、特异度、阳性预测值和阴性预测值分别为100%、77.7%、78.7%、100%。22例RVH患者进行介入治疗,高度可能组的18例患者中16例治疗有效,不确定组中3例无效、1例有效。结论 卡托普利介入99mTc-EC肾动态显像是诊断RVH的有效手段,同时能预测患者血管成形术治疗效果。Abstract: Objective To show the value of captopril renal scintigraphy for detecting a renovascular cause in hypertensive patients and to assess the ability to predict the beneficial effect of revascularization on renal function. Methods Fifty-five consecutive patients with suspected renovascular hypertension (RVH) underwent renal scintigraphy after injection of 99mTc ethylenedicysteine (99mTc-EC) after oral administration of 50 mg captopril given 60 min before the test. Baseline scintigraphy was performed 24 h later if the 99mTc-EC results were abnormal. Results 20 patients had renal artery stenosis(RAS) in 22 patients whom scintigraphy had a high probability of RVH. The result was indeterminate in 10 patients, 5 of them had RAS. In 23 patients found a low probability RVH. In 18 of 22 patients with a high probability RVH by scintigraphy, revascularization procedures were performed and 16 patients had beneficial effects, 1 of 4 patients with intermediate RVH had beneficial effects. Conclusion Captopril renal scintigraphy can detect and can predict the beneficial effect of revascularization in some cases.
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