动脉粥样硬化患者肾动脉狭窄患病率的调查

Investigation of the prevalence of renal artery stenosis in atherosclerotic patients population

目的探讨动脉粥样硬化患者中肾动脉狭窄(ARAS)的患病率及其危险因素。方法2002年10月-2003年11月,以存在冠心病、脑血管病和(或)下肢血管血栓栓塞性疾病的患者作为动脉粥样硬化人群的选择标准,对这些患者行肾动脉造影,同时对比分析ARAS患者与无ARAS的动脉粥样硬化患者的临床特点。结果218例动脉粥样硬化性疾病患者中,24.3%存在ARAS。冠心病、脑血管病、下肢血管血栓栓塞性疾病患者中,ARAS的检出率分别为27.9%、30.0%和40.0%。ARAS的患病率有随年龄增加的趋势。66.0%的ARAS患者没有典型的症状,为造影过程中的"意外诊断"。同无ARAS的患者相比,这些患者合并颈动脉狭窄的比例较高(71.4%比35.9%,P<0.01)。结论ARAS在动脉粥样硬化性疾病人群中的患病率为24.3%。ARAS在下肢血管血栓栓塞性疾病的人群中检出率最高,应加强在动脉粥样硬化人群中,特别是周围血管病伴颈动脉狭窄的人群中对ARAS的筛查。

Objective To investigate the prevalence of atherosclerotic renal artery stenosis (ARAS) and risk factors in the atherosclerotic patient population. Methods A prospective study was undertaken during Oct 2002 to Nov 2003. Renal angiography was performed to screen the presence of renal artery disease among patients with variety of atherosclerotic disease, including coronary heart disease, cerebrovascular disease and lower-extremity occlusion disease. Before the angiography, clinical data were collected. Clinical features were compared between ARAS patients and non-ARAS ones in order to explore the risk factors. Results Two hundred and eighteen patients with coronary artery disease, cerebrovascular disease or lower-extremity occlusion disease were enrolled in the study. ARAS (≥50% diameter narrowing by angiography) was identified in 53 (24.3%) of all the patients. Insignificant renal artery stenosis ( < 50% diameter narrowing ) was found in 33 cases (15.1% ). The prevalence of ARAS in patients with coronary artery disease, cerebrovascular disease or lower-extremity occlusion disease was 27.9% ,30% and 40% respectively. The more the number of atherosclerotic organs involved, the greater the likehood of renal artery stenosis existed. Sixty-six percent of ARAS was diagnosed 'accidentally'. These 'accidental diagnosis' ARAS patients had a higher rate of carotid artery stenosis compared with non-ARAS patients (71.4% vs 35.9% ,P< 0.01). Conclusions ARAS is not rare among patients with atherosclerotic diseases. Screening for ARAS should be taken in atherosclerotic patients, especially with lower-extremity occlusion disease and/or carotid artery stenosis.