动脉粥样硬化性肾动脉狭窄的患病率及危险因素分析

Prevalence and risk factors of atherosclerotic renal artery stenosis

目的探讨冠脉造影患者中动脉粥样硬化性肾动脉狭窄（ARAS）的患病率及其危险因素。方法1996年1月至2006年12月，北京协和医院心内科因疑诊和确诊冠心病（CAD），同时行冠状动脉造影（CAG）及。肾动脉造影术（RAG）患者2506例，任1支或2支肾动脉狭窄≥50％诊断为ARAS。分析ARAS患病率，同时进行单因素及多因素Logistic回归，分析其危险因素。结果2506例患者，男1479例，女1027例，平均年龄（62．7±11．4）岁，ARAS患者409例（16．3％），其中≥75％狭窄214例（8．5％）；双侧肾动脉狭窄98例（3．9％），其中双侧狭窄≥75％27例（1．1％）；单侧左肾ARAS162例（6．5％），其中狭窄≥75％84例（3．4％）；单侧右肾ARAS149例（5．9％），其中狭窄≥75％72例（2．9％）。单因素分析筛选后，Logistic回归分析发现，年龄〉65岁（P=0．025，OR=1．358）、女性（P〈0．01，OR=1．678）、高血压（P〈0．01，OR=1．650）、外周血管疾病（P〈0．01，OR=14．678）、肾功能不全（P〈0．01，OR=1．835）、冠状动脉3支病变（P〈0．01，OR=1．746）及左主干病变（P〈0．01，OR=3．416）是ARAS的独立危险因素。结论年龄〉65岁、女性、有高血压、外周动脉疾病，血清肌酐升高以及冠心病尤其是3支及左主干病变患者，应行肾动脉评估，尽早发现ARAS。

Objective To explore the prevalence and risk factors of atheroselerotic renal artery stenosis （ARAS） in patients undergoing coronary angiography. Methods A total of 2506 patients with suspected and known coronary heart disease（CAD） at our hospital underwent simultaneous coronary and renal angiography. Renal artery stenosis was defined as at least one of renal artery stenosis≥50% narrowing of luminal diameter. The prevalence of ARAS was summarized from the results of angiography. And single- and multi-variable logistic regression analysis was used to assess the relationship between clinical characteristics and ARAS. Results Among them, there were 1479 males and 1027 females with a mean age of 62. 7 ± 11.4 years. ARAS was detected in 409 patients （ 16. 3% ）, including 214 （8.5%） with significant stenosis （ ≥75% ） ; Bilateral ARAS was detected in 98 patients （3.9%）, including 27 （ 1.1% ） with significant stenosis （≥75% ）. Left and right ARAS were detected in 162 patients （6. 5% ） and 148 patients （5.9%） respectively, including 84 patients （3.4%） with significant stenosis （ ≥75% ） in left ARAS and 72 patients （2. 9% ） in right ARAS. Univariate analysis indicated that age, females, diabetes, hypertension, stroke, peripheral artery disease, coronary heart disease, renal insufficiency, dyslipidemia and hyperuricemia were the predictor for ARAS（ P 〈 0. 05 or 0. 01 ）. Multivariate regression analysis demonstrated that age ≥65 years （P = 0. 025, OR = 1. 358 ）, females （ P 〈 0.01, OR = 1. 678 ）, hypertension （ P 〈 0. 01, OR = 1. 650 ）, peripheral artery disease（P 〈0. 01, OR = 14. 678） , renal insufficiency（P 〈0. 01, OR = 1. 835） , coronary heart disease including 3-vessel （ P 〈 0. 01, OR = 1. 746） and left main coronary （ P 〈 0.01, OR = 3.416） disease were independent risk factors for ARAS. Conclusion Renal angiography should be routinely performed in female patients aged t〉 65 years with hypertension, peripheral artery disease, elevated creatinine and coronary heart disease, especially for 3-vessel and left main coronary disease to identifyARAS in time.