粥样硬化性肾动脉狭窄与肾功能之间的关系探讨

Relationship between atherosclerotic renal artery disease and renal function

目的评价粥样硬化性肾动脉狭窄患者肾功能与肾动脉狭窄之间的关系。方法97例经造影明确的粥样硬化性肾动脉狭窄患者,根据肾动脉狭窄程度分组,测定肌酐清除率,并对其中20例患者行同位素肾图测定分肾肾小球滤过率。结果肾动脉狭窄〈50%组和狭窄≥50%组中肾功能正常者分别占49.1%和47.6%,与肾动脉正常组（占71.4%）比较有统计学差异（P〈0.05）;肾小球滤过率在肾动脉狭窄〈50%、50%-70%及≥70%组分别为（71.14±18.95）、（67.22±18.58）和（64.11±26.33）ml/min,组间比较无统计学差异（P〉0.05）;分肾肾小球滤过率与肾动脉狭窄程度之间无明显相关性（r=-0.208,P〉0.05）。结论肾动脉狭窄患者发生肾功能不全的可能性增大,但肾动脉狭窄程度的轻重不是影响肾功能的主要因素,肾实质损害可能在肾功能不全发病中起主要作用。

[ Objective] To investigate the relationship between renal function and severity of proximal renal arterial lesions in patients with atherosclerotic renal artery stenosis （ARAS） . [ Methods] Creatinine clearance in a cohort of 97 patients of ARAS diagnosed by renal artery angiography was measured. In addition, 20 patients＇ individual kidney function was estimated by radionuclide renography. [ Results ] Compared with patients with normal renal artery, fewer patients with ARAS 〈50% or ARAS≥50% had normal renal function. No differences in renal function （creatinine clearance） were seen among patients with ARAS 〈50%, ARAS50%-70% or ARAS≥70%. No correlation existed between residual patency and creatintine clearance （ r = - 0. 208, P 〉 0.05） . [ Conclusions ] Patients with ARAS may have renal dysfunction, but the severity of stenosis do not correlate with the severity of renal dysfunction. Renal parenchymal damage plays more important role in renal dysfunction.