同期冠状动脉和肾动脉支架术对心肾功能的影响  

Impact of simultaneous renal artery and coronary artery stenting on cardiac and renal function inpatients with renal artery stenosis and coronary artery disease

作　　者：董豪坚[1] 莫与京[1] 刘媛[1] 罗建方 周颖玲[1] 黄文晖[1] 

机构地区：[1]广州广东省心血管病研究所广东省人民医院心内科广东省医学科学院,510100

出　　处：《中华心血管病杂志》2014年第1期19-24,共6页Chinese Journal of Cardiology

基　　金：广东省科技计划项目（20108031500019）

摘　　要：目的观察同期行冠状动脉和肾动脉支架术对冠心病合并肾动脉狭窄患者心肾功能的影响，并分析影响患者长期预后的因素。方法入选2006年1月至2010年1月确诊的冠心病合并肾动脉狭窄患者169例，其中同期行冠状动脉和肾动脉支架术（联合组）149例，单纯行冠状动脉支架术（PCI组）20例。术后至少随访2年，记录基线及随访血压、血肌酐水平、超声心动图检查结果以及不良心肾脑血管事件。结果PCI组左右肾动脉狭窄率均低于联合组（P均〈0．叭）。术后2年，联合组收缩压低于基线（P〈0．01），舒张压与基线比较差异无统计学意义（P〉0．05）；PCI组收缩压及舒张压均低于基线（P均〈0．01）；超声心动图显示，2组患者的左心室心肌重量指数均低于基线（P均〈0．01），联合组较PCI组下降幅度更大（-55．6g／m2。比-12．8g／m。，P〈0．01）；联合组估算肾小球滤过率（eGFR）小于基线[（41．7±18．9）ml·min～·1．73m。比（44．7±17．4）ml·min～·1．73111，P〈0．01]；PCI组手术前后eGFR差异无统计学意义（P〉0．05）。对联合组患者的多因素Cox回归分析显示，基线肾功能不全不是不良心肾脑血管事件的危险因素（HR：0．986，P〉0．05）。结论同期行冠状动脉和肾动脉支架术治疗冠心病合并肾动脉狭窄患者安全、有效，虽不能逆转肾功能下降，但有助于控制血压和减轻左心室肥厚。Objective To investigate the impact of simultaneous percutaneous transluminal renal artery stenfing （PTRAS） and percutaneous coronary artery interventions （PCI） on cardiac and renal function in patients with renal artery stenosis （RAS） and coronary artery disease （ CAD）, and explore the factors affecting the long-term prognosis. Methods This retrospective cohort study enrolled 169 patients with RAS and CAD from January 2006 to January 2010, 149 patients were intervened with PTRAS and PCI simultaneously （combined group） and the remaining 20 patients were treated with PCI （PCI group）. All patients were followed up for at least 2 years. Clinical data including blood pressure, estimated glomerular filtration rate （ eGFR ） , eehocardiography and major adverse events were obtained. Results The average stenotic ratio of the left and right renal artery in PCI group were significantly lower than those in combined group （both P 〈0. 01 ）. After 2 years, there was a significant decrease in systolic blood pressure compared to baseline level in the combined group （ P 〈 0. 01 ）. In the PCI group, both systolic blood pressure and diastolic blood pressure were significantly lower during follow-up than at the baseline level（ both P 〈 0. 01 ）. Echoeardiography examination showed that left ventricnlar mass index （LVMI） during follow up was significantly lower than the baseline value in both groups, and the reduction extent in the combined group was larger than in PCI group（ -55.6 g/m2 vs. - 12.8 g/mE ,P 〈0. 01 ）. In the combined group, the eGFR value decreased from （44.7 ± 17.4） ml ~ rain-l · 1.73 m-2 to （41.7 ± 18.9） ml ~ rain-l · 1.73 m （P 〈 O. 01 ）. eGFR level remained unchanged in PCI group（P 〉 0. 05 ）. Multivariate Cox regression analysis demonstrated that baseline renal dysfunction was not significantly related to the long-term adverse prognosis in combined group （ HR = O. 986, P 〉 0. 05 ）. Conclusions Simultaneous PTRAS and PCI are safe ande

关 键 词：冠状动脉疾病 肾动脉梗阻 支架 

分 类 号：R543.3[医药卫生—心血管疾病]