重度肾动脉狭窄支架置入前、后的皮质血流灌注变化特点和短期预后的危险因素分析  被引量:7

Changes of cortical blood perfusion before and after treatment of severe renal artery stenosis and its risk factors for short-term prognosis

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作  者:郭发金[1] 马娜[1] 张玥伟 王思宇[1] 孙由静[1] 李梦璞 艾虎[2] 朱辉[3] 王杨 任俊红[1] 李拥军[4] Guo Fajin;Ma Na;Zhang Yuewei;Wang Siyu;Sun Youjing;Li Mengpu;Ai Hu;Zhu Hui;Wang Yang;Ren Junhong;Li Yongjun(Department of Sonography,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Vascular Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Medical Research&Biometrics Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China)

机构地区:[1]北京医院超声科,国家老年医学中心,中国医学科学院老年医学研究院,100730 [2]北京医院超声科,国家老年医学中心,中国医学科学院心内科,100730 [3]北京医院超声科,国家老年医学中心,中国医学科学院核医学科,100730 [4]北京医院超声科,国家老年医学中心,中国医学科学院血管外科,100730 [5]中国医学科学院,阜外医院医学研究统计中心,国家心血管病中心,100037

出  处:《中国心血管杂志》2021年第2期159-164,共6页Chinese Journal of Cardiovascular Medicine

基  金:北京医院临床研究121工程资助项目(BJ-2018-198);北京医院院级课题(2018-001);中国医学科学院中央级公益性科研院所基本科研业务费项目(2019PT320012)。

摘  要:目的观察重度肾动脉狭窄(RAS)患者支架置入前后的皮质血流灌注特点,并分析影响预后的危险因素。方法单中心回顾性自身前后对照研究。连续纳入2017年10月至2020年7月北京医院收治的82例单侧重度RAS行支架置入治疗的患者。超声造影评估支架治疗前、后和随访3个月的皮质血流灌注特点。记录出院后12个月不良心肾血管事件(包括肾功能恶化、永久肾替代治疗、再次肾动脉重建治疗、心肌梗死、心力衰竭和死亡),应用LASSO回归和多因素logistic回归分析影响预后的危险因素。结果82例患者平均年龄为(57.3±16.9)岁,男性44例(53.7%),33例(40.2%)有陈旧心肌梗死,平均左室射血分数为43.7%±12.6%,肾动脉狭窄程度为82.5%±10.2%。超声造影结果显示,较支架置入前,支架置入后和术后3个月随访时的上升支、下降支曲线下面积和峰值强度均明显增加,而上升时间、达峰时间和平均渡越时间均明显延长(均为P<0.05);较支架置入后,术后3个月时的上升支曲线下面积明显增加,达峰时间和平均渡越时间均有明显缩短(均为P<0.05)。平均随访(11.5±1.7)个月,共有16例(19.5%)发生不良心肾血管事件。多因素logistic回归分析显示年龄>74岁(OR=1.353)、糖尿病(OR=1.741)、高血压≥2级(OR=1.646)、左室射血分数<43.7%(OR=1.934)、肾功能≥3期(OR=2.551)和上升支曲线下面积﹤850.0 dB×s(OR=2.890)均是心肾血管事件的相关危险因素,β受体阻滞剂(OR=0.804)是其保护因素。结论重度RAS患者术后的皮质血流灌注较术前明显改善,而皮质血流灌注是影响短期预后的重要指标之一。Objective To observe the characteristics of cortical blood perfusion before and after stent implantation in patients with severe renal artery stenosis(RAS),and analyze the risk factors for prognosis.Methods This was a single-center retrospective self-control study.A total of 82 consecutive patients with unilateral severe RAS who were admitted to Beijing Hospital from October 2017 to July 2020 for stent implantation were enrolled.Ultrasound contrast was used to evaluate the characteristics of cortical blood perfusion before and after stent implantation,and at 3 months of follow-up.Cardio-renal vascular adverse events(including worsening renal function,permanent renal replacement therapy,renal artery revascularization,myocardial infarction,heart failure,and death)were recorded during the 12 months of follow-up.LASSO regression and multivariate logistic regression were used to analyze the related risk factor.Results Among the 82 patients,44 were males(53.7%),with an average age of(57.3±16.9)years.Besides,33 patients(40.2%)had previous myocardial infarction,the average left ventricular ejection fraction was 43.7%±12.6%,and average renal artery stenotic degree was 82.5%±10.2%.The contrast-enhanced ultrasound results showed that compared with before stent placement,the ascending and descending area under the curve and peak intensity were significantly increased,and the ascending time,peak time and mean transit time were significantly prolonged after stent placement and at 3 months of follow-up(all P<0.05).Compared with parameters after the stent implantation,the ascending area under the curve was significantly increased,and the peak time and mean transit time were significantly shortened(all P<0.05).The average follow-up was 11.5±1.7 months,and 16 cases(19.5%)had cardio-renal vascular events.Multivariate logistic regression analysis showed that age>74 years(OR=1.353),diabetes(OR=1.741),hypertension≥class 2(OR=1.646),LVEF<43.7%(OR=1.934),chronic kidney disease≥stage 3(OR=2.551)and ascending AUC<850 dB×s(OR=2.89

关 键 词:重度肾动脉狭窄 心肾血管事件 肾皮质血流灌注 危险因素 

分 类 号:R54[医药卫生—心血管疾病]

 

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