132例动脉粥样硬化性肾动脉狭窄临床分析

Clinical analysis of 132 patients with atherosclerotic renal artery stenosis

目的探讨动脉粥样硬化性肾动脉狭窄(ARAS)患者的临床特点,评价介入治疗和单纯药物治疗对肾功能预后的影响。方法分析本院经肾动脉造影确诊的ARAS患者132例的临床资料。88例单侧ARAS按年龄≤70岁和>70岁分组及按基础GFR≥60 ml／min和GFIR< 60 ml／min分组,比较介入治疗和药物治疗对GFR的影响。44例双侧ARAS按行双侧、单侧、非介入治疗分组,比较3组差异。结果单侧ARAS、年龄≤70岁者,介入治疗1年后GFR变化值优于药物治疗组(P<0．05);基础GFR≥60 ml／min者,介入治疗1年后GFR变化值优于药物治疗组(P<0．05);年龄>70岁,GFR<60 ml／min者,介入治疗与药物治疗相比,GFR变化值无显著性差异。双侧ARAS者双侧介入治疗GFR变化值优于单侧介入,单侧介入优于非介入治疗组。Logistic回归分析示基础GFR≥60 ml／min,进行介入治疗的单侧AKAS者,肾功能(GFR)的预后较好。结论单侧ARAS年龄≤70岁,介入治疗前GFR≥60 ml／min者,介入治疗后肾功能 (GFR)预后较好;年龄大于70岁的患者,介入前应仔细评估,慎重选择介入治疗。

Objective To evaluate the prognostic result of renal function on atherosclerotic renal artery stenosis （ARAS） patients after revascularization and medication therapy. Methods The clinical data of 132 ARAS patients diagnosed by renal angiography were analysed. For comparing the differences of glomerular filtration rate （GFR） between revascularization and medication therapy, 88 patients with unilateral ARAS were divided into two groups： ≤ 70 and 〉70 years old, meanwhile, according to GFR, these patients were divided into ≥60 and 〈60 ml/min groups. Forty-four patients with bilateral ARAS were divided into bilateral, unilateral and non-revascularization three groups according to the treatment, and differences were compared among these three groups. Results In unilateral ARAS patients, the GFR variety after 1-year revascularization was better than that of medication therapy in ≤ 70 years old group and GFR ≥ 60 ml/min group. There were no differences of GFR variety between revascularization and medication in 〉 70 years old group and GFR 〈 60 ml/min group. In 44 bilateral ARAS patients, the GFR variety was better in bilateral revascularization group than that of other two groups. Logistic regression analysis showed that the revascularization and the GFR≥60 ml/min were positively correlated with the prognosis of renal function. Conclusions 1-year revascularization indicates a better prognosis of renal function for unilateral ARAS patients with age ≤ 70 years and GFR ≥ 60 ml/min. As for the ARAS patients older than 70 years old, revascularization must be estimated carefully in details.