老年动脉粥样硬化性肾动脉狭窄介入治疗的疗效及相关因素分析  

Clinical effect analysis of intervention treatment for patients with atherosclerotic renal artery stenosis

作　　者：钱芸娟[1] 郝文科[1] 姚坚坚[1] 詹如冰[1] 陈静[1] 余枫[1] 

机构地区：[1]广东省人民医院广东老年医学研究所肾脏内科,广东广州510080

出　　处：《中国实用内科杂志》2007年第24期1937-1939,共3页Chinese Journal of Practical Internal Medicine

基　　金：广东省医学科学技术基金(A2002011)

摘　　要：目的评价介入方法治疗老年动脉粥样硬化性肾动脉狭窄的疗效及临床相关因素。方法分析2001年1月至2004年12月广东省人民医院经肾动脉造影确诊肾动脉粥样硬化性肾动脉狭窄并经介入治疗的79例老年患者的治疗效果与临床因素的相关性。结果介入治疗后血压获益(治愈及改善)者占69.6%(55/79),无效者占30.4%(24/79);肾功能改善与稳定者占35.4%(28/79),无效者占64.6%(51/79)。单因素相关分析发现,介入治疗后血压的获益与术前蛋白尿及肾小球滤过率、术前收缩压及舒张压、术前肾动脉阻力指数有关;肾功能的获益与肾动脉狭窄的比例、术前用药的数量、术前24h蛋白尿显著相关。Logistic多因素逐步回归分析发现,肾动脉狭窄的程度是影响介入治疗高血压疗效的独立因素;而年龄、血肌酐是影响肾功能疗效的独立因素。结论肾动脉狭窄程度≥85%、年龄<75岁、治疗前血肌酐>133μmol/L的老年人动脉粥样硬化性肾动脉狭窄介入治疗效果较好。Objeetlve To evaluate the clinical outcome and relative factors of intervention treatment for atherosclerotic renal artery stenosis in elderly patients. Methods The clinical data of 79 patients diagnosed as atherosclerotic renal artery stenosis by angiography and treated by revascularization were analyzed. Results There were 55 （69. 6% ） successes and 24 （30. 4% ）failures in decreasing blood pressure and 28 （35.4%）successes and 51 （64. 6% ）failures in improving renal function after intervention treatment. Predictors of favorable outcome of intervention treatment in decreasing blood pressure were related to lower urine protein, higher glomerular filtration rate, higher systolic and diastolic blood pressure before treatment,lower resistance index （RI）of renal artery, and no complication of cerebral vascular diseases. Predictors of favorable outcome of intervention treatment in improving renal function were related with percentage of angiographic stenosis,category of antihypertension and lower urine protein. The logistic regression analysis showed that the percentage of angiographic stenosis was the most important predictor of intervention treatment for blood pressure control, age and level of serum creatinine before intervention treatment were the most important predictors of intervention treatment for improving renal faction. Conclusion Percentage of stenosis（ ≥85% ） ,age（ 〈75 years old）and level of serum creatinine（ 〉 133 μmol/L） can be used as the predictors of therapeutic success for renovascular stenosis in older patients.

关 键 词：动脉硬化 肾动脉狭窄 介入治疗 

分 类 号：R5[医药卫生—内科学]