老年冠心病患者顺路肾动脉造影的意义  

Study on the examination of selective coronary angiography and renal artery angiography simultaneously in elderly patients with coronary heart disease

作　　者：张丽伟[1] 黄党生[1] 沈东[1] 罗北捷[1] 张许文[1] 

机构地区：[1]中国人民解放军总医院第一附属医院心内科,北京市100037

出　　处：《实用老年医学》2009年第2期120-122,共3页Practical Geriatrics

摘　　要：目的探讨老年冠心病患者中肾动脉狭窄的发病率,明确与动脉硬化性肾动脉狭窄(ARAS)的相关危险因素。方法总结我院262例因拟诊冠心病而行冠状动脉造影并常规术中顺路行选择性双肾动脉造影的老年患者的临床资料,分析老年冠心病患者中ARAS的发病率。以ARAS为自变量,行Logistic多元回归分析,明确ARAS的危险因素。结果262例患者共发现ARAS 48例(18.3%),其中中度狭窄34例(13.0%),重度狭窄14例(5.3%)。明确诊断冠心病的193例中,ARAS的发生率为22.2%,明显高于无冠心病患者(3.6%)(P<0.05)。多因素Logistic回归分析,预测ARAS的独立危险因素为:女性、血肌酐(Scr)异常、左主干病变、冠状动脉三支病变。结论老年冠状动脉粥样硬化患者中ARAS的发生率较高,冠状动脉造影的同时行顺路肾动脉造影安全可行。但ARAS与冠状动脉疾病并不完全平行,女性、Scr异常、左主干病变及冠状动脉三支病变是老年ARAS的独立危险因素。Objective To evaluate the prevalence of atherosclerotic renal artery stenosis（ARAS） in elderly patients undergoing selective coronary angiography and renal angiography simultaneously, to determine the relationship of ARAS and coronary artery disease（ CAD）, and to investigate the related risk factors of ARAS. Methods A total of 262 elderly patients with suspected CAD underwent selective renal artery angiography immediately after coronary angiography. Independ- ent sample test and multivariate logistic regression analysis were used to study the independent risk predictors of ARAS. Results Forty-eight（ 18.3% ） ARAS cases were found in 262 patients,with 34（ 13.0% ） and 14（5.3% ）cases of medium and severe ARAS respectively. The incidence of ARAS in 193 patients with CAD （22. 2% ） was significantly higher than that of patients without CAD （ P 〈 0.05 ）. By the multivariate logistic regression analysis, the important related factors with ARAS were female sex, early renal dysfunction, 3-vessel lesions and LM lesion in coronary arteries. Conclusions It is useful to perform selective renal artery angiography following coronary angiography. Female sex, early renal dysfunction, CAD with 3-vessel lesions and LM lesion are the independent risk factors for ARAS in elderly people.

关 键 词：老年人 粥样硬化性肾动脉狭窄 冠心病 选择性冠状动脉造影 肾动脉造影 

分 类 号：R541.4[医药卫生—心血管疾病]