粥样硬化性肾动脉狭窄合并高血压患者RAAS活性及介入术后血压改善影响因素分析  

Analysis of RAAS activity in patients with atherosclerotic renal artery stenosis and hypertension and influencing factors of blood pressure improvement after endovascular therapy

作　　者：刘敏 黄琦 刘凯 田丹丹 郭林雅 张晨 孔德慧 张清慧 杜慧宇 屈慧云 王伊菲 郝义彬 LIU Min;HUANG Qi;LIU Kai;TIAN Dandan;GUO Linya;ZHANG Chen;KONG Dehui;ZHANG Qinghui;DU Huiyu;QU Huiyun;WANG Yifei;HAO Yibin(Department of Hypertension,Zhengzhou University People′s Hospital(Henan Provincial People′s Hospital),Zhengzhou 450003;Department of Clinical Medicine,Henan University,Zhengzhou 450046;Department of Clinical Medicine,Zhengzhou University,Zhengzhou 450001;Zhengzhou University People′s Hospital(Henan Provincial People′s Hospital),Zhengzhou 450003)

机构地区：[1]郑州大学人民医院(河南省人民医院)高血压科,郑州450003 [2]河南大学临床医学系,郑州450046 [3]郑州大学临床医学系,郑州450001 [4]郑州大学人民医院(河南省人民医院),郑州450003

出　　处：《郑州大学学报（医学版）》2024年第3期380-385,共6页Journal of Zhengzhou University(Medical Sciences)

基　　金：国家自然科学基金面上项目(82270463);河南省医学科技攻关项目(LHGJ20210025,LHGJ20220002);河南省重点研发专项(231111313400)。

摘　　要：目的:探讨粥样硬化性肾动脉狭窄(ARAS)合并高血压患者的肾素-血管紧张素-醛固酮系统(RAAS)活性及介入术后血压改善的影响因素。方法:选择2018年1月至2023年6月于河南省人民医院就诊经肾动脉造影确诊的69例ARAS合并高血压患者(ARAS组),以1∶2的比例纳入年龄、性别相匹配的同期入院的138例原发性高血压(EH)患者。分析EH组、ARAS组人口学信息、高血压病程等临床特征,比较EH组、单侧ARAS组、双侧ARAS组的RAAS活性。比较ARAS介入前后肾功能,采用Logistic回归分析ARAS介入术后血压改善的影响因素。结果:ARAS组患者的BMI、合并症比例、收缩压、脉压、血肌酐高于EH组;高血压病程、肾小球滤过率估计值(eGFR)、血钾短/低于EH组(P<0.05)。与EH组相比,单侧ARAS组的血浆肾素活性、血管紧张素Ⅱ、醛固酮较高,醛固酮与肾素比值、血钾较低;双侧ARAS组血浆肾素活性较高,血钾较低;与单侧ARAS组相比,双侧ARAS组血浆醛固酮浓度较低(P<0.017)。ARAS介入治疗前后肾功能比较,差异无统计学意义(P>0.05)。ARAS介入术后血压改善与eGFR(OR=0.928,95%CI为0.875~0.984,P=0.012)有关。结论:ARAS合并高血压患者的RAAS明显激活;术前eGFR较低的患者更有可能经由介入手术得到血压的改善。Aim:To investigate the renin-angiotensin-aldosterone system(RAAS)activity in patients with atherosclerotic renal artery stenosis(ARAS)and hypertension and influencing factors of the improvement of blood pressure after endovascular therapy.Methods:A total of 69 patients with ARAS combined with hypertension diagnosed by renal arteriography who attended Henan Provincial People′s Hospital from January 2018 to June 2023(ARAS group)were selected,and 138 age and gender-matched patients with essential hypertension(EH)admitted during the same period were included at a ratio of 1∶2.Clinical characteristics such as demographic information and duration of hypertension were analyzed in the EH and ARAS groups,and RAAS activity was compared among EH,unilateral ARAS,and bilateral ARAS groups.Renal function of ARAS patients was compared before and after endovascular therapy,and the factors influencing the improvement of blood pressure in ARAS patients after the intervention were analyzed using Logistic regression.Results:Compared with the EH group,BMI,comorbidity ratio,systolic blood pressure,pulse pressure and serum creatinine were higher in the ARAS group,the duration of hypertension,estimated glomerular filtration rate(eGFR)and serum potassium were lower in the ARAS group(P<0.05).Compared with the EH group,the unilateral ARAS group had higher plasma renin activity,angiotensinⅡ,and aldosterone,and lower aldosterone-to-renin ratio and serum potassium;the bilateral ARAS group had higher plasma renin activity and lower serum potassium(P<0.017).Plasma aldosterone concentration was lower in the bilateral ARAS group compared with the unilateral ARAS group(P<0.017).There was no significant difference in renal function before and after endovascular therapy in ARAS patients(P>0.05).eGFR(OR=0.928,95%CI was 0.875-0.984,P=0.012)was associated with improvement of blood pressure after endovascular therapy in ARAS patients.Conclusion:RAAS is activated in ARAS and hypertension patients;patients with lower preoperative eGFR are more likel

关 键 词：粥样硬化性肾动脉狭窄 肾素-血管紧张素-醛固酮系统 介入治疗 高血压 

分 类 号：R544.1[医药卫生—心血管疾病]