冠脉造影患者中动脉粥样硬化性肾动脉狭窄的临床研究

The prevalence and risk factors of atherosclerotic renal artery stenosis in patients undergoing coronary angiography

目的探讨冠状动脉造影患者中动脉粥样硬化性肾动脉狭窄(ARAS)的患病率及其相关因素。方法228例冠状动脉造影患者同时行选择性双肾动脉造影检查,对其临床资料与ARAS之间的关系进行单因素和多因素Logistic回归分析。结果228例患者中,ARAS患病率为19.7%;经冠状动脉造影证实的152例冠状动脉粥样硬化性心脏病(简称冠心病)患者中,ARAS患病率为27.6%;51例冠心病合并颈动脉粥样斑块的患者中,ARAS患病率为49.0%。单因素分析表明,年龄、顽固性高血压、糖尿病、肾功能不全、颈动脉粥样斑块、冠心病是ARAS的预测因素。多元Logistic回归分析表明,仅年龄、顽固性高血压、颈动脉粥样斑块、冠状动脉3支病变是ARAS的独立预测因素。结论对于冠心病患者,尤其是冠状动脉3支病变、年龄≥60岁、有顽固性高血压及颈动脉斑块的患者,冠脉造影后应常规行肾动脉造影,以便早期发现ARAS。

Objective To investigate the prevalence and risk factors of atherosclerotic renal artery stenosis （ARAS） in patients undergoing coronary angiography. Methods Selective renal angiography was performed immediately in 228 patients after coronary angiography. Clinical data and angiography results were analyzed by univariate and multivariate logistic regression. Results In 228 patients undergoing coronary angiography, the prevalence of ARAS was 19.7%, meanwhile that was 27.6% in 152 patients with coronary artery diseases. In 51 patients with coronary artery disease and carotid artery atherosclerotic plaques,the prevalence of ARAS was 49.0%. In 45 ARAS patients, the prevalence of left renal artery stenosis was significantly higher than that of the right （P〈0.05）. Univariate analysis indicated that age, diabetes, renal insufficiency, carotid artery atherosclerotic plaques and coronary artery disease were the risk factors for ARAS. Multivariate regression demonstrated that age, carotid artery atherosclerotic plaques and coronary artery triple vessel lesion were identified as independent risk factors for ARAS. Conclusion Renal angiography should be routinely performed in patients with coronary artery disease undergoing coronary angiography to identify ARAS, especially for patients above 60 of age with carotid artery atherosclerotic plaques.