冠心病患者合并肾动脉狭窄的介入治疗及临床随访

Effects and clinical follow-up of percutaneous renal artery intervention in patients with renal artery stenosis and coronary artery disease

目的评价冠心病合并肾动脉狭窄患者行肾动脉介入治疗术的疗效和安全性。方法2002年1月至2007年6月,对我院行冠状动脉造影患者做选择性肾动脉造影检查,68例伴有肾动脉显著狭窄(管腔狭窄≥70%)的患者入选本研究。进行肾动脉支架置入术和至少6个月的临床随访,比较行经皮腔内肾动脉支架术患者术前及随访期6个月时血清肌酐(SCr)和血压变化。结果68例肾动脉狭窄患者(70处病变)均成功进行了经皮介入治疗,置入肾动脉支架,无严重并发症发生,与术前比较,平均SCr轻度降低,但差异无统计学意义。术前肾功能异常的17例患者,肾功能好转8例(47.1%)、无变化7例(41.2%)、恶化2例(11.7%)。51例术前肾功能正常的患者,SCr仍在正常范围。经皮肾动脉支架术后,平均血压显著降低[术后6个月:(141.4±10.3/80.1±11.3)mmHg,与基础测值比较,P<0.01]。术后6个月,9例不用药物治疗血压保持正常,48例抗高血压用药减少[术前(3.2±1.5)种,术后(2.1±1.1)种,P<0.01],血压控制良好(<140/90mmHg)。结论对于冠心病合并肾动脉狭窄患者行肾动脉介入治疗术,手术成功率高,对患者肾功能及控制血压具有明显作用。

Objective To evaluate the effects and safety of percutaneous renal artery intervention in patients with renal artery stenosis and coronary artery disease. Methods 68 patients with severe renal artery stenosis （luminal diameter narrowing ≥ 70% ） and clinical hypertension received renal artery stenting from January 2002 to June 2007. The changes in blood pressure and serum creatinine level were assessed after intervention and at 6 monthsj follow-up. Results Percutaneous renal artery intervention was performed in 70 stenotic arteries of 68 patients,and 70 stents were implanted. The procedural success rate was 100% and there were no severe complications. At 6 months follow-up, the average serum creatinine level was slightly decrease compared with pre-procedure. There was no statistical significance. Creatinine level decreased in 8 patients, remained stable in 58 patients, and increased in 2 patients. Despite conventional medical treatment, systolic and diastolic blood pressures were also significantly decreased after stenting （141.4±10.3/80.1±11.3 mm Hg at 6 months,P〈0.01）,and hypertension was well controlled in 83.8% of patients at 6 months＇follow-up. No deaths occurred during 6-months follow-up. Conclusion The procedure of renal artery intervention has a high technical success rate and is effective in improving renal function and blood pressure for patients with renal artery stenosis.