影响冠心病并肾动脉狭窄患者肾动脉支架术后血压改善因素的探讨

The predictors to blood pressure outcomes after renal stenting in patients with coronary and renal artery disease

目的:探讨影响冠心病并肾动脉狭窄患者肾动脉支架术后血压改善的因素。方法:选取88例随访资料完整并术前并发高血压的冠心病患者。根据随访结果,将达到美国心脏协会(AHA)指南的肾动脉支架术后随访血压改善标准的53例作为血压改善组,其余35例血压无改善的为未改善组。比较2组临床特征和支架术后随访结果,并作多因素回归分析。结果:两组均成功行肾动脉支架置入术,入选患者术后总体血压改善率为60.2%。与血压改善组比较,血压未改善组患者年龄较高[(74.7±7.0)∶(69.6±7.8)岁,P<0.05],女性较多(62.9%∶35.9%,P<0.05),肾小球滤过率较低[(41.7±20.5)∶(50.4±20.3)ml/min,P<0.05]。多因素分析显示,年龄和性别是影响肾动脉狭窄患者支架术后血压改善的预测因素。结论:60%的冠心病并肾动脉狭窄患者肾动脉支架术后血压能得到改善,但高龄和女性患者术后血压获益较少。

Objective：To investigate the predictors that may influence the blood pressure outcomes after renal stenting in patients with both coronary artery disease and renal artery stenosis. Method.. According to the guidelines of AHA for renal interventional therapy, as well as the results of follow-up, 88 consecutive patients with renal artery stenosis were divided into 2 groups, including 53 patients with successful improvement of blood pressure （Group Ⅰ ） and 35 patients with unchangeable blood pressure after renal stenting （Group Ⅱ ）. The baseline clinical characteristics were compared between the two groups. A multi-variable regression was carried out on the significant factors to analysis the predictor that may influence the outcomes. Result： All enrolled cases received renal interventional therapy successfully, and the mean rate of BP improvement in the whole enrolled cases was 60.2%. As compared with those in the GroupⅡ , the patients in the Group Ⅰ were elder[（74.7±7.0）vs （69.6±7.8）, P 〈0.05], more females（62.9% vs 35.9%, P 〈0.05）and had lower glomerular infiltration rates [（41. 7±20. 5） ml/min vs （50.4± 20.3） ml/min, P 〈0.05]. Multi-variable regression revealed that the factors of age and gender can predict BP outcomes after renal stenting. Conclusion：The 60% patients with renal artery stenosis achieve BP improvement after renal interventional therapy. However, senile and female patients appear to have poor BP response during follow-up.