2型糖尿病合并肾动脉狭窄相关危险因素临床分析  

The risk of diabetes complicated with renal artery stenosis and clinical detection method

作　　者：李明[1] 敖华[1] 陈文祥[1] 何爱红[1] 刘勇强[1] 张秋玲[1] 张盛[1] 

机构地区：[1]三峡大学第三临床学院葛洲坝中心医院肾内科,宜昌443002

出　　处：《临床肾脏病杂志》2014年第11期678-681,共4页Journal Of Clinical Nephrology

摘　　要：目的：探讨糖尿病合并肾动脉狭窄相关危险因素与高效临床检测方法，以期能及时发现糖尿病合并肾动脉狭窄患者，极早治疗，避免肾功能恶化。方法对120例糖尿病合并肾功能不全，或者难治性高血压的患者，应用肾动脉 CTA检查，根据有无肾动脉狭窄分为2组，收集各组患者年龄、血压、糖尿病病程、吸烟及冠心病病史等情况，彩超检查两肾长径差值、叶间动脉 RI 、肾动脉血流流速及颈动脉内膜厚度，实验室检查血肌酐、尿蛋白、血脂、胱抑素 C、糖化血红蛋白及同型半胱氨酸等指标。结果 DSA证实肾动脉CTA阳性患者均有不同程度肾动脉狭窄，肾动脉狭窄患者的年龄、血压、叶间动脉 RI 、肾动脉血流流速及颈动脉内膜厚度、血脂、胱抑素 C、糖化血红蛋白及同型半胱氨酸等指标均与非狭窄组有明显统计学差异，其中胱抑素C、糖化血红蛋白及同型半胱氨酸呈正相关。而2组患者两肾长径差值、血肌酐、尿蛋白无统计学差异。结论肾动脉 CTA检查发现肾动脉狭窄的准确率高达100%。糖尿病患者的年龄、高血压水平，糖尿病病程、高血脂、肾动脉血流流速、叶间动脉 RI 、颈动脉内膜厚度联合血清胱抑素C、糖化血红蛋白及同型半胱氨酸等指标可以及早发现肾动脉狭窄，可作为预测糖尿病动脉狭窄的指标应用于临床。Objective To explore the risk factors of diabetes complicated with renal artery ste-nosis and effective clinical detection method,and discover the diabetic patients with renal artery steno-sis treated as soon as possible to avoid the deterioration of renal function.Methods 1 20 cases of diabe-tes complicated with renal insufficiency,or refractory hypertension were divided into two groups ac-cording to the results of DSA.The age,blood pressure,diabetes duration,history of smoking and coronary heart disease,etc were recorded.The length difference of two kidneys,interlobar artery re-sistance index,renal artery blood flow velocity and carotid intima-media thickness were detected by color Doppler ultrasound.Serum creatinine,urine protein,blood lipids,Cystatin C,HbA1 c and ho-mocystein were determined.Results DSA confirmed that all renal artery CTA positive patients had different degrees of renal artery stenosis.Ages,blood pressure,interlobar artery resistance index,re-nal artery blood flow velocity,carotid intima-media thickness,blood lipids,Cystatin C,HbA1 c and homocystein were of great significance between two groups.Cystatin C,HbA1 c and homocystein were positively correlated,but the length difference of two kidneys,serum creatinine and urine protein had no statistically significant difference between two groups.Conclusions The accuracy rate of renal ar-tery CTA detecting renal artery stenosis was 1 00%.The age of the patients with diabetes,blood pres-sure level,diabetes duration,hyperlipidemia,interlobar artery resistance index,renal artery blood flow velocity,carotid intima-media thickness,Cystatin C,HbA1 c and homocystein were helpful to find renal artery stenosis earlier.The indicators can be used in clinical practice to predict renal artery stenosis.

关 键 词：糖尿病 肾动脉狭窄 胱抑素C 糖化血红蛋白 同型半胱氨酸 

分 类 号：R692.16[医药卫生—泌尿科学]