药物与支架治疗对中度无症状动脉粥样硬化性肾动脉狭窄患者血压及肾功能影响的研究  

The effect of renal angioplasty and medical therapy on blood pressure and renal function in asymptomatic ARAS patients with stenosis of 50%～70%—a prospective controlled study

作　　者：张欣[1] 王梅[2] 左力[1] 

机构地区：[1]北京大学第一医院肾内科,北京100034 [2]北京大学人民医院肾内科,北京100044

出　　处：《中国实用内科杂志》2010年第3期220-222,226,共4页Chinese Journal of Practical Internal Medicine

基　　金：卫生部临床学科重点项目(20010913)

摘　　要：目的观察支架治疗对狭窄程度50%～70%的无症状动脉粥样硬化性肾动脉狭窄(ARAS)患者在血压及肾功能方面的影响。方法将2003年9月至2008年5月北京大学第一医院66例无症状ARAS患者分为支架组与药物组各33例。比较两组血压、降压药物剂量(DDD)及肾功能,并比较两组血压与肾功能获益率。结果平均随访(19±7)个月(12～36个月),(1)血压:药物组无论血压或服用降压药物剂量均无明显下降,支架组术后所需的降压药物剂量明显下降[(0.97±0.88)DDD对(1.31±0.72)DDD,P<0.05];收缩压明显下降[(132±12)mmHg对(140±20)mmHg,P<0.05)]。随访12个月时,支架组所需的降压药物剂量明显少于药物组[(1.08±0.76)DDD对(1.79±0.75)DDD,P<0.01],血压获益率明显高于药物组(58.1%对9.4%,P<0.01)。(2)肾功能:随访期间,药物组肾功能下降[(63.2±14.0)mL/(min.1.73m2)对(70.4±16.4)mL/(min.1.73m2),P<0.01)],而支架组肾功能稳定。12个月时两组在eGFR与肾功能获益率方面差异无统计学意义[(64.6±15.8)mL/(min.1.73m2)对(63.2±14.0)mL/(min.1.73m2),P>0.05;81.8%对72.7%,P>0.05)]。结论对于狭窄程度50%～70%的无症状ARAS患者,支架治疗使所需降压药物剂量减少,血压易于控制,延缓肾功能下降。Objective To study the effect of medical therapy and renal angioplasty on blood pressure and renal function in asymptomatic ARAS patietnts with stenosis between 50% - 70%. Methods Sixty-six asymptomatic ARAS patients with unilateral or bilateral renal artery stenosis ranged from 50% to 70% were divided into renal angioplasty group （ n = 33 ） and medical therapy group （ n = 33 ）. Blood pressure, antihypertensive dosage （ defined as daily dosage, DDD） and renal function （Scr, eGFR ） were monitored, and the beneficial effect on the blood pressure（ cure or improve） and renal function （improve or stabilize） were also evaluated. Results After the （ 19 ± 7）months（12-36 months） of follow-up,both blood and renal function changed as followed： （1） Blood pressure： Compared to the baseline, neither blood pressure nor antihypertensive dosage changed in medical therapy group, while in angioplasty group, antihypertensive dosage decreased significantly [ （0. 97 ± 0. 88）DDD vs （1.31 ± 0. 72） DDD,P 〈 0. 05 ） ]. （ 2 ） Renal function ： Compared to the baseline, eGFR decreased [ （ 63.2 ± 14. 0 ） mL/ （ min · 1.73 m^2 ） vs （70. 4 ± 16. 4） mL/（ min · 1.73 m^2 ）,P 〈 0. 01 ] in medical therapy group, but did not alter in angioplasty group. At 12 months,no significant difference was observed between the two groups either on eGFR [ （ 64. 6 ± 15. 8 ） mL/（ min · 1.73 m^2 ） vs （63.2 ± 14. 0） mL/（ min · 1.73 m^2 ）,P 〉 0. 05 ] or the beneficial effect on renal function （81.8% vs 72. 7% ,P〉 0.05）. Conclusion Renal angioplasty showed a drug-dosage-saving effect on blood pressure and seemed to protect the renal function from deterioration in asymptomatic ARAS patients with stenosis ranged from 50% to 70%. Large-sealed and long-term studies are needed to verify our results.

关 键 词：肾动脉梗阻 动脉粥样硬化 高血压 动脉支架 

分 类 号：R5[医药卫生—内科学]