动脉粥样硬化性肾动脉狭窄支架术后强化降脂或常规降脂治疗对肾功能的影响：一项前瞻性随机对照研究  

The effect of intensive lipid lowering versus standard lipid lowering on renal function in patients with atherosclerotic renal artery stenosis undergoing renal artery stenting:aprospective,randomized controlled trial

作　　者：彭猛[1] 蒋雄京[1] 董徽[1] 车武强[1] 李彬[1] 邹玉宝[1] 钱海燕[1] 宋雷[1] 张慧敏[1] 吴海英[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外医院心内科,北京100037

出　　处：《中华高血压杂志》2017年第3期232-238,共7页Chinese Journal of Hypertension

摘　　要：目的比较动脉粥样硬化性肾动脉狭窄支架术后强化降脂与常规降脂治疗对肾功能的影响是否存在差异。方法入选2013年6月至2014年12月成功行肾动脉支架术的150例动脉粥样硬化性肾动脉狭窄住院患者,1∶1随机分配到强化降脂组[低密度脂蛋白胆固醇(LDL-C)目标值<1.8mmol/L]和常规降脂组(LDL-C目标值1.8~<3.3mmol/L),两组均服用瑞舒伐他汀,在2个月内调整LDL-C至各自的目标值并维持,其他治疗方案两组间一致。研究主要终点为术后6个月的估算的肾小球滤过率(eGFR)和尿微量白蛋白/肌酐。次要终点为术后6个月的降压药物种数、诊室血压、支架再狭窄率和心血管临床事件。结果两组的临床基线特征差异无统计学意义。术后6个月时,强化降脂组LDL-C低于常规降脂组[(1.51±0.32)比(2.32±0.47)mmol/L,P<0.01];eGFR高于常规降脂组[(92.0±29.3)比(79.5±19.4)mL/(min·1.73 m^2),P<0.01],eGFR较基线升高值也高于常规降脂组[16.7(3.6~24.6)比1.5(-9.5~8.7)mL/(min·1.73 m^2),P<0.01];尿微量白蛋白/肌酐低于常规降脂组[45.3(19.8~64.0)比55.4(26.0~121.8)mg/g,P=0.037],尿微量白蛋白/肌酐较基线下降值高于常规降脂组[31.7(2.3~54.4)比-6.6(-17.6~31.1)mg/g,P<0.01]。次要终点方面,术后随访中两组的降压药物种数和诊室血压较基线水平均有显著下降,但组间差异无统计学意义,两组支架再狭窄率及主要临床事件的差异也无统计学意义(均P>0.05)。结论粥样硬化性肾动脉狭窄患者在肾动脉支架术后强化降脂较常规降脂可带来更多肾功能保护作用。Objective To investigate how intensive lipid lowering affects renal function when compared with stand- ard lipid lowering in patients with atherosclerotic renal artery stenosis undergoing renal artery stenting. Methods Between June 2013 and December 2014, a total of 150 patients with atherosclerotic renal artery stenosis undergoing renal artery stenting were randomly （1 ： 1 ） assigned to receive intensive lipid lowering treatment [the goal of low density lipoprotein cholesterol, LDL-C（1.8 mmol/L] or standard lipid lowering treatment （the goal of LDL-C 1.8-（3.3 mmol/L）. All patients received rosuvastatin. LDL-C was lowered to the target within two months and appropriate treatment was maintained. No significant difference existed in the treatment regimens other than lipid-lowering between the two groups. The primary end points were estimated glomerular filtration rate （eGFR） and urinary albumin to creatinine ratio at 6 months. The secondary end points were the number of antihypertensive medications, the clinic blood pressure, the restenosis rater cardiovascular clinical events at 6 months. Results The baseline clinical characteristics were comparable between two groups. At 6 month follow-up, LDL-C was lower inthe patients with intensive lipid lowering than with standard lipid lowering [（1.51±0. 321 vs （2. 32±0.47） mmol/L, P〈0.01]; eGFR[（92. 0±29. 3） vs （79.5±19.4） mL/（min ± 1.73 m2 ）, P〈0.01] and the increase of eGFR [16.7 （3.6-24.6） vs 1.5（-9.5-8.7） mL/（min · 1.73 m2 ）, P〈0.01] were higher in the patients with intensive lipid lowering than with standard lipid lowering ; urinary albumin-creatinine ratio [45.3 （ 19.8 - 64.0 ） vs 55.4 （ 26.0 - 121.8） mg/g, P=0. 037] was lower and the decrease of urinary albumin-creatinine ratio was higher [31. 7（2.3- 54.4） vs -6.6（-17.6-31.1） mg/g, P〈0.01] in the patients with intensive lipid lowering than with standard lip- id lowering. In term of secondary end points, the number of antihypertensive medica

关 键 词：粥样硬化性肾动脉狭窄 降脂治疗 支架术 瑞舒伐他汀 

分 类 号：R692[医药卫生—泌尿科学]