冠心病患者肾动脉狭窄及其相关因素分析

The prevalence and predictors of renal artery stenosis in patients with coronary artery disease

目的 探讨接受冠状动脉造影及冠心病患者合并肾动脉狭窄的发生率及其危险因素。方法 对连续 15 7例接受冠状动脉造影的患者进行腹主动脉数字减影血管造影检查。结果 15 7例患者中 ,肾动脉狭窄发生率为 14 0 % ;经冠状动脉造影证实的 81例冠心病患者中 ,肾动脉狭窄的发生率为 2 5 9% ;冠状动脉造影完全正常的 62例患者中 ,无 1例有肾动脉狭窄。多元Logistic回归分析表明 ,冠心病、糖尿病及血肌酐 >10 0 μmol/L是存在肾动脉狭窄的独立预测因素。 结论 对冠心病合并高血压、糖尿病、特别是血肌酐 >10 0 μmol/L的患者 ,冠状动脉造影时应常规进行腹主动脉造影检查 ,以尽早发现肾动脉狭窄。

Objective To determine the prevalence of renal artery stenosis and its predictors in patients with documented coronary artery disease. Methods Abdominal digital subtraction angiography (DSA) was performed immediately after coronary angiography to detect and quantify renal artery stenosis (RAS) in 157 consecutive patients with known or suspected coronary artery disease. Results RAS(defined as ≥50% diameter stenosis) was detected in 22 of the 157 patients (14.01%) and 21 of the 81 patients with coronary artery disease(25.93%) who had at least one coronary artery of ≥50% diameter stenosis, while no RAS was found in patients whose coronary angiograms were normal. By multivariate logistic regression analysis, coronary artery disease, diabetes mellitus and serum creatinine level>100 μmol/L were identified as independent predictors of RAS. Conclusion Abdominal DSA should be routinely performed in patients with coronary artery disease undergoing coronary angiography to identify RAS, especially in those associated with diabetes mellitus and elevated serum creatinine level.