冠状动脉造影患者中高血压合并肾动脉狭窄发生率及其影响因素

Incidental renal artery stenosis in hypertensive patients undergone coronary angiography

目的:在冠状动脉造影人群中观察高血压合并肾动脉狭窄(RAS)的发生率,并分析高血压合并RAS的影响因素。方法:高血压合并胸痛进行冠状动脉造影检查的患者157例,其中男性81例(51.5%),女性76例(48.5%),收缩压(151.5±17.4)mmHg(1mmHg=0.133kPa)舒张压(94.7±10.3)mmHg,在冠状动脉造影结束后,进行选择或非选择性肾动脉造影。分别以年龄、性别、收缩压、舒张压、高脂血症、糖尿病、吸烟和冠状动脉病变严重程度为自变量,以RAS为因变量进行单因素和多变量Logistic回归分析RAS与危险因素之间的关系。结果:入选157例,其中126例(80.2%)肾动脉造影正常,另31例(19.6%)存在RAS(腔径狭窄≥30%),其中14例(8.9%)存在显著的RAS(腔径狭窄≥50%),17例(10.8%)存在轻度狭窄(30%≤直径狭窄<50%),6例(3.8%)存在显著单侧RAS(腔径狭窄≥70%),2例(1.2%)存在显著双侧RAS(腔径狭窄≥70%)。冠状动脉造影结果,确诊冠心病79例,非冠心病78例,冠心病患者中单支血管病变29例,双支病变25例,三支病变21例,左主干合并三支病变4例。单因素分析显示年龄、收缩压、糖尿病和冠状动脉病变严重程度与RAS有关;而多因素回归分析,独立预测因子为年龄(OR=1.17,95%可信区间:1.05～1.38,P<0.01)和冠状动脉病变的严重程度(OR=1.46,95%可信区间:1.03～2.04,P<0.01)。结论:接受冠状动脉造影检查的患者,高血压合并RAS的发生率高。因此,有高血压患者接受冠状动脉造影术时应考虑行肾动脉造影术。

Objective： To evaluate the prevalence of renal stenosis in hypertensive patients population undergoing routine coronary angiography, and to identify the risk factors for renal stenosis. Method： Before the procedure,demographic data, medical history, physical findings sere obtained. In 157 patients（ 81 male, 76 female）, mean systolic blood pressure was （151.5 ± 17.4 ）mmHg, and mean diastolic blood pressure was （94.7 ± 10.3 ） mmHg. After coronary angiography, selective or non-selective renal artery angiography was performed to screen for the presence of renal artery stenosis. An univariate and multivariate Logistic regression analysis were made to explore the association of renal artery stenosis with the clinical variables, including age, sex, systolic blood pressure, diastolic blood pressure, hyperlipidemia, smoking, diabetic mellitus and severity of coronary artery disease. Result： Of the 157 patients, 126 patients（80.2%） had normal renal arteries, and 31 patients（19.6%） had renal artery stenosis, including 17 patients（ 10.8% ） had renal artery 30%-50% stenosis, and 14 patients（8.9% ） had stenoses of 50% or more. Significant unilateral stenosis（≥ 70 % ） was present in 6（3.8 % ） patients and bilateral stenosis was present in 2 （1.2 % ） patient. There were 79 cases with coronary artery disease and 78 subjects without coronary artery disease. Of the all patients with coronary artery disease, there were 29 single-vessel,25 double-vessel,21 triple-vessel disease and 4 left main disease accompanying with triple-vessel disease. An univariate analysis showed age, systolic blood pressure, diabetic mellitus and severity of coronary artery disease were associated with renal artery stenosis. In multivariate analysis,age（OR = 1.17,95% CI： 1.05-1.38, P 〈 0.01 ） and severity of coronary artery disease（OR = 1.46,95% CI： 1.03-2.04, P 〈 0. 01 ） independently correlated with renal artery stenosis. Conclusion： The prevalence of incidental renal artery stenosis among hypertensive patients undergoing coronary catheterization is significant. Therefore, screening nenal arteriograyrly should be considered in hypertensive patients undergoing coronary angiography.