冠心病患者合并肾动脉狭窄的危险因素分析  

Relative risk factors of patients with coronary heart disease combined with renal artery stenosis

作　　者：傅文霞 王效增[1] 张磊[1] 姚莹 刘丽稳 荆全民[1] 

机构地区：[1]沈阳军区总医院心内科,沈阳110016

出　　处：《解放军医学杂志》2017年第12期1078-1082,共5页Medical Journal of Chinese People's Liberation Army

基　　金：国家临床重点专科军队建设项目(2017)~~

摘　　要：目的探讨冠心病患者中动脉粥样硬化性肾动脉狭窄(ARAS)的相关危险因素。方法纳入2016年5月-2016年9月因疑诊和确诊冠心病连续就诊于沈阳军区总医院行选择性冠状动脉造影术及非选择性肾动脉造影术的患者677例,分析肾动脉狭窄的发生率,根据肾动脉狭窄程度将患者分为肾动脉正常组(肾动脉造影正常)、肾动脉轻度狭窄组(肾动脉狭窄<50%)和肾动脉明显狭窄组(肾动脉狭窄≥50%),采用单因素及多因素logistic回归分析冠心病合并ARAS的危险因素。结果 677例患者中,肾动脉明显狭窄发生率为18.9%(128/677),肾动脉轻度狭窄发生率为16.7%(113/677)。肾动脉狭窄患者的年龄、收缩压、脉压、肌酐均高于肾动脉正常组(P<0.05),女性、高血压、左主干病变比例与肾动脉正常组相比差异均有统计学意义(P<0.05);肾动脉轻度狭窄组冠脉双支病变比例高于肾动脉正常组(P<0.05)。肾动脉明显狭窄组年龄、脉压、肌酐水平明显高于其他两组(P<0.05),且外周血管病变、左主干病变、冠脉单支及三支病变比例明显高于其他两组(P<0.05)。单因素及多因素logistic回归分析结果显示,年龄、女性、外周血管病变、冠脉多支病变是ARAS的独立危险因素。结论高龄、女性、伴有外周血管病变的冠心病患者易发生肾动脉狭窄,在冠状动脉造影的同时应行肾动脉造影,以尽早发现ARAS,并进行肾动脉评估。Objective To investigate the risk factors of atherosclerotic renal artery stenosis （ARAS） in patients with coronary heart disease. Method Six hundred and seventy-seven patients with suspected or certainly diagnosed as coronary heart disease consecutively underwent selective coronary angiography and non-selective renal artery angiography during May to Sep. 2016 in the Department of Cardiology of General Hospital of Shenyang Military Region. According to the degree of renal artery stenosis, the subjects were divided into renal artery normal group, renal artery slight stenosis group （renal artery stenosis 〈50%） and renal artery obvious stenosis group （renal artery stenosis _〉50%）. Both univariate and multivariate logistic regression analysis were used to study the independent risk predictors of ARAS. Results By analysis of clinical data, it was found that age, systolic blood pressure, pulse pressure and creatinine level were higher in patients with different degrees of renal artery stenosis than in renal artery normal group （P〈0.05）. There were significant differences in different degrees of renal artery stenosis groups in female, hypertension, left main coronary artery （P〈0.05）. The proportion of coronary double vessel lesions was higher in renal artery slight stenosis group than in renal artery normal group （P〈0.05）. Age, pulse pressure and creatinine level were significantly higher in renal artery obvious stenosis group than in the other two groups （P〈0.05）. Peripheral vascular disease, left main coronary artery disease, single coronary artery and three vessel disease were significantly higher than that in other two groups （P〈0.05）. The incidence of renal artery obvious stenosis was 18.9% in patients with renal artery obvious stenosis, and was 16.7% in renal arteries slight stenosis group. By univariate and multivariate Logistic regression analysis, age, female, peripheral vascular disease, and multivessel coronary artery disease were independent risk factors for ARAS

关 键 词：肾动脉狭窄 动脉粥样硬化 危险因素 冠状动脉疾病 

分 类 号：R543.5[医药卫生—心血管疾病]