氮质血症期动脉粥样硬化性肾动脉狭窄患者的临床特征  

Clinical characteristics of azotemic renovascular disease

作　　者：张帆[1] 杨进刚[2] 

机构地区：[1]首都医科大学附属北京同仁医院,北京100730 [2]北京协和医学院中国医学科学院阜外心血管病医院,北京100037

出　　处：《岭南心血管病杂志》2011年第6期438-442,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨存在动脉粥样硬化性肾动脉狭窄(atherosclerosis renal artery stenosis,ARAS)的氮质血症患者的临床特征。方法回顾性分析北京同仁医院心血管中心诊断并随访的41例ARAS氮质血症患者的临床资料,所有患者均为双侧肾动脉狭窄(≥50%)且血清肌酐浓度≥133μmol/L(1.5 mg/dL)。结果 41例患者的年龄为(68.3±7.7)岁,血清肌酐浓度为(611.8±53.2)μmol/L。有33例(82.5%)病变累及双侧肾动脉,8例(19.5%)为孤立肾的肾动脉狭窄。37(90.2%)例有原发性高血压(高血压)病史,高血压的持续时间为(13.7±8.9)年。30例(73.2%)正在吸烟或曾有吸烟史;29例(71.7%)高脂血症;13例(31.7%)糖尿病。并存其他的心血管病变情况:39例(95.1%)冠状动脉粥样硬化性心脏病(冠心病),22例(53.7%)下肢血管病变,18例(43.9%)有脑卒中病史。11例(26.8%)接受了肾动脉支架植入治疗,随访(18.0±8.6)个月,2例(18%)肾功能好转,2例(18%)恶化,其余7例(64%)肾功能稳定。共14例死亡或发生主要心血管事件,事件组的射血分数(53.0%±13.4%vs.61.8%±10.8%,P=0.004)显著低于无事件组,24 h尿蛋白定量[(1.2±0.9)g/24 h vs.(0.7±0.3)g/24 h,P<0.001)显著高于无事件组,差异均有统计学意义。结论氮质血症的老年患者并存有多处其他血管病变时,应注意除外肾动脉狭窄。射血分数较低和24 h尿蛋白浓度较高的患者近期发生心血管事件的危险高。Objectives To observe the clinical characteristic of patients with azotemic renovascular disease. Methods Clinical data of 41 patients with azotemic renovascular disease in Caridiovascular Center, Tongren Hospital were retrospectively analyzed. Inclusion criteria were the presence of bilateral renal artery stenosis 〉50% and serum concentration of creatinine ≥ 133 μmol/L （1.5 mg/dL）. Results A total of 41 patients were included. Their mean age was （68.3 ± 7.7） years, and secrum concentration of creatinine was （611.8±53.2） μmol/L. In 33 （82.5%） of the patients, the lesion affected both renal arteries, and 8 （19.5%） of the cases were patients with renal artery stenosis in solitary kidney. Hypertension with a duration （13.7±8.9） years was present in 37 （90.2%） of the cases. Smoking habits was in 30 （73.2%） of the cases, hyperlipidemia was in 29 （71.7%） of the cases and diabetes was in 13 （31.7%） of the cases. Associated cardiovascular diseases were very frequent： coronary heart disease in 39 （95.1%） of the cases, lower limbs artery disease in 22 （53.7%） of the cases and apoplexy in 18 （43.9%） of the cases. Sixteen stents were successfully placed in 11 （26.8%） patients,and they were followed up for （18.0±8.6）months. Serum creatinine of 2 （18%） patients was improved, 2 （18%） patients deteriorated and the other 7 （64%） patients remained stable. [ncidences of death and cardiovascular event occurred in 14 （34.1%） patients. Ejection fraction in event group （53.0%±13.4% vs. 61.8%±10.8%,P=0.004） was significantly lower than that in non-event group and 24 h urine protein quota [（1.2±0.9） g/24 h vs. （0.7±0.7） g/24 h,P〈0.001 ] was significantly higher than that in non-event group. Conclusions Ischemic renal disease should be suspected in elderly patients with chronic renal insufficiency and cardiovascular disease at other levels. Patients with higher proteinuria and lower ejection fraction have a higher risk of cardiovascul

关 键 词：动脉粥样硬化 肾动脉狭窄 肾功能不全 氮质血症 

分 类 号：R543.5[医药卫生—心血管疾病]