动脉粥样硬化性肾动脉狭窄患者肾动脉支架术后肾功能的长期变化及相关因素分析  

Long term outcome of PTRA and stenting in patients with atherosclerotic renal artery stenosis and predictors analysis

作　　者：张欣[1] 王梅[2] 左力[1] 杨敏[3] 邹英华[3] 

机构地区：[1]北京大学第一医院肾脏内科,100034 [2]北京大学人民医院肾脏内科 [3]放射介入与血管外科

出　　处：《中国介入心脏病学杂志》2009年第5期267-271,共5页Chinese Journal of Interventional Cardiology

基　　金：卫生部临床学科重点项目(20010913)

摘　　要：目的评价支架术对动脉粥样硬化性肾动脉狭窄（ARAS）患者肾功能的长期影响。方法56例单侧或双侧肾动脉狭窄程度≥70%的ARAS患者行肾动脉支架术。患者于术后1个月及以后每3～6个月随访一次,记录血压、血肌酐及降压药物剂量。使用中国公式计算估测肾小球滤过率（eGFR）,并评价24个月时血压、肾功能的改善与获益率。结果平均随访33.8±10.5（24～54）个月。（1）血压在术后1个月即明显下降,术后24个月时进一步下降（SBP 129.1±12.9 mmHg比139.2±17.5 mmHg;DBP 72.6±7.1 mmHg比80.6±12.8 mmHg,P均〈0.01）。高血压治愈率6.7%,改善率31.0%,获益率37.7%。（2）SCr与GFR在随访过程中保持稳定,24个月时与基线相比无明显变化[（SCr 125.8±64.4μmol/L比124.3±52.1μmol/L;eGFR59.3±18.9 mL/（min.1.73m2）比60.8±23.0 mL/（min.1.73 m2）,P均〉0.05]。肾功能改善率9.3%,稳定率62.9%,获益率72.2%。（3）Logistic回归分析显示,男性与糖尿病是肾功能恶化的独立危险因素（OR=11．1，5．88；P均〈0．05）。肾动脉狭窄程度与肾功能预后不相关。结论支架治疗使肾功能稳定。肾动脉狭窄程度不影响肾功能预后。男性、糖尿病是肾功能恶化的独立危险因素。Objective To evaluate the long term effect of PTRAS on renal function in ARAS patients.Methods Fifty-six patients with unilateral or bilateral renal artery stenosis ＆gt;70% were treated with stents.Patients were followed at 1 month and then every 3 to 6 months.Blood pressure and serum creatinine were measured and dosage of antihypertensive drugs were recorded.The Chinese equation was used to calculate estimated GFR.Results The mean follow-up period was 33.8±10.5（24-54） months. （1） Compared with baseline, blood pressure decreased siginificantly at 1 month and gained a further decrease at 24 months （SBP 129. 1 ± 12. 9 mmHg vs 139. 2 ± 17.5 mmHg; DBP 72. 6 ±7.1 mmHg vs 80. 6 ± 12. $ mmHg, both P 〈 0. 01 ）. Hypertension was cured in 6. 7% and improved in 31.0% of patients, and the overall benefit rate was 37.7%. （2） SCr and GFR were stable during the follow-up as no significant difference was observed at 24 months when compared with baseline （SCr 125.8 ±64.4 μmol/L vs 124.3 ± 52. 1 μmol/L; eGFR 59.3 ± 18.9 mL/（min.1.73 m^2） vs 60. 8 ±23.0 mL/（min·1.73 m^2） , respectively, both P 〉0. 05）. Renal function was improved in 9. 3% and stabilized in 62. 9% of patients, and the overall benefit rate was 72.2%. （3） Logistic analysis revealed that male and diabetes were independent risk factors for renal function deterioration （ OR = 11.1 and 5.88, respectively, both P 〈 0. 05）. Severity of stenosis was not associated with renal outcome. Conclusion PTRAS could stabilize renal function in ARAS patients. Male and diabetes were independent risk factors for renal function aggravation. Severity of stenosis did not affect renal function outcome.

关 键 词：肾动脉梗阻 动脉粥样硬化 支架 肾小球滤过率 

分 类 号：R692[医药卫生—泌尿科学] R692.05[医药卫生—外科学]