高血压病合并肾动脉狭窄患者的凝血及纤溶功能

Coagulation and Fibrinolytic System of Renal Artery Stenosis in Hypertensive Patients undergoing Coronary Angiography

目的:探讨高血压病合并肾动脉狭窄(renal artery stenosis,RAS)患者的凝血及纤溶功能。方法:对高血压病合并胸痛患者,在进行冠状动脉造影检查同时进行肾动脉造影检查,测定凝血系统中内皮素(ET-1)、血管血友病因子(vWF)和纤溶系统中血浆组织型纤溶酶原激活剂(tPA)、纤溶酶原激活剂抑制物(PAI-1)。比较高血压病合并RAS组和非RAS组血中凝血和纤溶系统指标水平有无差异,同时比较冠心病组和非冠心病组,冠状动脉单支、双支和三支血管病变组与正常组之间这些凝血与纤溶指标有无差异。结果:(1)157例患者,其中126例(80.2%)患者肾动脉造影正常,另31例患者(19.6%)存在RAS(腔径狭窄≥30%),其中17例患者(10.8%)存在轻度狭窄(30%≤腔径狭窄<50%),14例患者(8.9%)存在显著的RAS(腔径狭窄≥50%),包括5例患者(3.2%)存在显著单侧RAS(腔径狭窄≥70%),2例患者(1.2%)存在显著双侧RAS(腔径狭窄≥70%);(2)RAS组与非RAS组比较,凝血系统中ET-1和vWF明显升高,而纤溶系统中t-PA显著降低、PAI-1明显升高,组间比较差异有统计学意义(P<0.05);(3)冠心病组与非冠心病组比较,ET-1、vWF和PAI-1水平升高,tPA水平降低,根据冠状动脉造影结果,多支病变组与正常组比较ET-1、vWF、tPA和PAI-1水平差异有统计学意义(P<0.05),但单支病变组与正常组比较ET-1、tPA和PAI-1水平差异无统计学意义(P>0.05);(4)RAS同时合并冠心病组与冠心病组、RAS组的ET-1、vWF和PAI-1水平均高于对照组,而tPA水平低于对照组,在RAS合并冠心病组差异有统计学意义(P<0.01)。结论:接受冠状动脉造影检查患者,高血压病合并RAS的发生率高。高血压病合并RAS患者,尤其是合并有冠心病时,凝血功能亢进而纤溶功能降低。

Objective：To evaluate the relationship between coagulation fibrinolytic system and angiographically-determined renal stenosis in hypertentive patients undergoing routine coronary angiography. Methods： Before the procedure, demographic data, medical history, physical findings and laboratory data were obtained. In 157 patients （81 male, 76 female）, mean age was 61.4 ± 9.2 years（rang from 39 to 79 years）, mean systolic blood pressure was 151.5 ± 17.4 mmHg,and mean diastolic blood pressure was 94.7 ± 10.3mmHg. After coronary angiography, non selective abdominal aortography was performed to screen for the presence of renal artery stenosis . The differences of some parameters of coagulation and fibrinolytic system between the renal artery stenosis（RAS） and non-RAS （NRAS） groups, and coronary artery disease （CAD） and non-CAD （NCAD） groups, and also single vessel,double-vessel, triple-vessel disease and control groups were compared. Results： （1）Among the 157 patients , 126 patients （80.2 % ） had normal renal arteries, and 31 patients （19.6%） had renal artery stenosis, including 17 patients（10.8% ） had renal artery from 30% to 50% stenosis, and 14 patients （8.9%） had stenoses of 50% or more. Significant unilateral stenosis（≥70%） was present in 6（3.8%） patients and bilateral stenosis was present in 2（1.2%）patients. （2） The content of endothelin-1 （ET-1） and the activity of yon Willebrand factor（vWF） were increased in the RAS group in comparison with the NRAS group. The activity of tissue plasminogen activator（tPA） was obviously） decreased, the activity of plasminogen activator inhibitor-1 （PAI-1）was increased in the RAS group in comparison with the NRAS group, respectively （P〈0.05） ,and also in the CAD group and NCAD group. （3）The level of ET-1, vWF, tPA and PAI-1 were different in patients of double-vessel and triple-vessel diseases groups in comparison with control group, respectively （P〈0. 05） ,but the level of ET-1, vWF and PAI-1 were no obvious difference between single-vessel and control group（P〉0.05 ）. （4） The content of ET-1, vWF and tPA were increased and PAI-1 was decreased in the RAS accompany with CAD group, RAS group and CAD group in comparison with control group, especially in RAS accompany with CAD group. Conclusions： The prevalence of incidental renal artery stenosis among hypertensive patients undergoing coronary catheterization is high. Hyperfunction of coagulation system and hypofunction of fibrinolytic system were more significant in patients with RAS and CAD accompanying with hypertension than patients without RAS on CAD.