糖尿病患者肾动脉狭窄支架术的疗效

Outcomes After Renal Artery Stenting in Diabetic Patients with Renal Artery Stenosis

目的评估糖尿病患者肾动脉狭窄支架术后肾功能和血压的变化。方法入选43例糖尿病合并单侧或双侧肾动脉明显狭窄行肾动脉支架术作为糖尿病组,选择同期43例行肾动脉支架术的非糖尿病患者作为对照组。比较两组一般情况、术后肾功能和血压的变化。结果术前糖尿病组血清肌酐和尿β2-微球蛋白水平较对照组明显增高(分别为135±17μmol/L比107±31μmol/L;175±72μg/L比139±57μg/L,P均<0.05),两组肾动脉狭窄程度、支架术成功率相似。术后6个月两组血清肌酐较术前下降,但糖尿病组血清肌酐水平仍明显高于对照组(127±31μmol/L比99±22μmol/L,P<0.05);术后6个月糖尿病组尿β2-微球蛋白含量较术前明显下降(134±17μg/L比175±72μg/L,P<0.05),但在控制血压获益方面较对照组差(44%比71%,P<0.05)。结论糖尿病肾动脉狭窄支架术后肾功能和血压控制改善程度较对照组差。

Aim To assess the outcomes after percutaneous renal artery stent implantation in diabetic patients with renal artery stenosis. Methods Forty-three patients with diabetes mellitus （DM） and severe uni-or bi-lateral renal artery stenosis （luminal diameter narrowing ≥70%） and receiving renal stent implantation were included （DM group）, and another 43 non-diabetic patients undergone renal artery stenting were served as controls. Basic characteristics and the changes in blood pressure and renal function including serum creatinine level, urine β2 micro-globulin （β2-MG） concentration and assessed glomcrular fihration rate were compared between two groups at baseline state and at 6 months＂ tollow-up. Results Betore stenting procedure, patients in DM group had higher serum creatinine （ 135±17 μmol/L vs 107 ± 31 μmol/L, P 〈 0.05） and urine β2-MG levels （ 175± 72 μg/L vs 139±57μg/L, P 〈 0.05 ）. And 31 renal arteries with lumen stenosis 〉≥70% were stented in the DM group, compared with 39 stents in the control group, and the procedural success rote was 100%. At 6 months＇ follow-up, creatinine level was decreased in both groups, but remains higher in DM group compared with the control （ 127± 31 μmol/L vs 99 ± 22 μmol/ L,P〈0.05）. In DM group the urine β2-MG was significantly decreased after procedure （134 ± 17 μg/L vs 175 ± 72μg/L, P〈0.05）. Despite conventional medical treatment, blood pressure remains poorly controlled in majority of patients （benefit is 44% in DM vs 71% in control,P〈0.05）. Conclusion Diabetic patients receiving renal artery stenting had a worse prognosis with respect to renal function improvement and blood pressure control than non-diabetic patients.