动脉粥样硬化性肾动脉狭窄介入治疗与药物治疗的临床分析  

The clinical comparison of interventional therapy with medicine therapy for atherosclerotic renal artery stenosis

作　　者：汤曾耀[1] 郑泽琪[2] 梅寒颖 黄鑫[3] 王琦[1] 曹原[1] 刘继文[1] 

机构地区：[1]江西省九江市第一人民医院心内科,332000 [2]南昌大学第一附属医院,南昌330000 [3]南昌大学第三附属医院,南昌330000

出　　处：《检验医学与临床》2013年第22期2939-2942,共4页Laboratory Medicine and Clinic

基　　金：江西省卫生厅重大招标(20104001)

摘　　要：目的动脉粥样硬化性肾动脉狭窄(ARAS)与心血管疾病等密切相关,介入治疗能解除动脉狭窄,但其临床疗效却受到质疑,本实验通过严格把握介入治疗指征,分析ARAS患者单纯药物优化治疗与药物合并介入治疗的临床疗效。方法选择2010年1月至2011年1月确诊为ARAS,其肾动脉狭窄程度大于或等于70%的患者,通过综合评价肾脏情况(肾脏大小、肾动脉狭窄程度、患侧肾小球滤过率、动脉狭窄处血流压力阶差等)、临床并发症等,选择药物优化治疗组(拒绝行介入治疗患者)或药物优化合并介入治疗组,记录患者治疗前后血压、血清肌酐、心功能、心血管事件、再入院次数等,随访1年,评价单纯药物优化治疗与介入合并药物治疗的临床疗效。结果共入选120例患者,介入组48例,药物组72例,两组基础资料差异无统计学意义,介入组治疗前后血压下降明显,其中3例治愈,24例血压改善,21例无效,服用降压药物数量前后比较差异无统计学意义,平均肌酐轻度降低;药物组需要服用更多降压药物控制血压,平均肌酐轻度升高。在ARAS合并心衰患者分组中,介入合并药物治疗能改善心衰患者心功能,减少1年内因心衰、心绞痛、肺水肿及再住院次数。结论介入合并药物治疗能更好地改善ARAS患者心功能,两者对血清肌酐改善均无明显影响。Objective Atherosclerotic renal artery stenosis （ARAS） is closely related to cardiovascular disea- ses. Interventional therapy can relieve artery stenosis,hut clinical effects have been challenged. Through strict control indications for interventional treatment,this research aims to evaluate the clinical curative effects between ARAS pa- tients treated with drugs only and patients treated with drugs combined with intervention. Methods 120 patients who were diagnosed as ARAS and renal artery stenosis area^70% have been recruited during the period of January 2010 to January 2011. Through comprehensive evaluations of kidney （renal size, renal artery stenosis degree, the ipsilateral glomerular filtration rate, pressure gradients across renal artery stenosis） and clinical complications, patients have been divided into drug therapy group （patients refused interventional therapy） and drug therapy combined with inter- ventional therapy group. Patients＂ blood pressure, serum creatinine, cardiac function, cardiovascular events and read- mission times were recorded before and after treatment. The followed up was one year. Results In the 120 patients, 48 cases were in interventional group, 72 cases were in drug group. In interventional group, the blood pressure im- proved significantly （P^0. 01）, 3 patient were cured, 24 patients blood pressure improved, 21 cases were invalid. There were no significant difference in the number of antihypertensive drug（P^0.05）, average serum creatinine re- duced mildly;Drug group needed to take more drugs to control blood pressure,and average serum creatinine elevated mildly. While in the group of ARAS patients combined with heart failure, interventional therapy can improve heart function of patients with heart failure, reduce the number of hospitalizations due to heart failure, angina and pulmona- ry edema within 1 year. Conclusion Intervention combined with drug therapy and drug therapy alone can both effec- tively control blood pressure, however the patients in interv

关 键 词：动脉粥样硬化 肾动脉狭窄 心衰 

分 类 号：R5[医药卫生—内科学]