动脉粥样硬化性肾动脉狭窄与分肾肾小球滤过率相关性研究

Relationship between renal artery stenosis and single kidney glomerular filtration rate in patients with atherosclerotic renovascular disease

目的探讨动脉粥样硬化性肾动脉狭窄(RAS)与分肾肾小球滤过率(SKGFR)之间的关系。方法 选取2004—2010年在首都医科大学附属北京同仁医院经肾动脉造影证实的动脉粥样硬化性肾动脉狭窄(狭窄程度≥50%)患者49例,采用99mTc-DTPA同位素肾图方法测定SKGFR,应用配对的t检验和多因素Logistic回归分析确定影响SKGFR的因素。结果 在49例患者中,单侧RAS患者26例,双侧肾动脉狭窄23例。其中7例存在一侧肾脏萎缩,9例的单侧肾动脉完全闭塞。没有肾脏萎缩的单侧RAS患者的双侧SKGFR差异无统计学意义[(25.90±9.20)mL/min对(25.71±11.32)mL/min,P=0.492]。但对于存在肾脏萎缩的单侧RAS患者,双侧的SKGFR差异有统计学意义[(7.47±2.4)mL/min对(31.14±16.4)mL/min,P=0.008]。9例存在一侧的肾动脉完全闭塞的患者,双侧的SKGFR差异有统计学意义[(4.96±1.10)mL/min对(40.27±17.60)mL/min,P=0.001]。多因素logistic回归分析显示,仅年龄(OR=1.75,95%CI 1.62～2.87,P=0.028)和糖尿病(OR=3.71,95%CI 1.09～12.56,P=0.035)与SKGFR显著降低有关,而未发现RAS、性别、吸烟、高血压和冠心病等因素与SKGFR有关。结论 对于单侧RAS患者,正常侧和狭窄侧肾脏的SKGFR差异无统计学意义。但完全闭塞和伴RAS的萎缩肾脏的SKGFR明显降低。RAS患者的分肾功能的受损程度与老年和糖尿病的关系更为密切。

Objective To investigate the relationship between renal artery stenosis （RAS） and single renal function in pa- tients with atherosclotic RAS. Methods Forty-nine patients were recruited from cardiovascular center or nephrology clinics in Beijing Tongren Hospital of Capital Medical University from 2004 to 2010, and RAS （ 〉 50% ） was confirmed by renal angiography. We detected the single kidney glomerular filtration rate （SKGFR） using ^99mTechnetium dimethyl triamine pen- taacetic acid （99mTc-DTPA） scintigraphy. Results Of the 49 patients,21 were found with unilateral RAS and 23 with hi- lateral HAS. Besides ,5 cases had unilateral renal atrophy and 8 cases had complete renal artery occlusion. We found SKGFR was not significantly different between bilateral kidneys in patients with unilateral RAS and no renal atrophy （ [ 25.90±9. 20 ] mL/min vs[ 25.71 ± 11.32 ] mL/min, P = 0. 492 ）. However, in patients with unilateral RAS and renal atrophy, the SKGFR was significantly different between the bilateral kidneys （ [ 7.47 ±2.4 ] mL/min vs [ 31.14 ± 16. 4 ] mL/min, P = O. 008 ）. In patients with unilateral renal artery occlusion, the SKGFR was significantly different between the bilateral kid- neys （ [ 4. 96 ±1.10 ] mL/min vs [ 40. 27±17.60 ] mL/min, P = 0. 001 ）. Multivariate logistic regression analysis showed that the age （ OR = 1.75,95% CI 1.62 - 2. 87, P = 0. 028 ） and diabetes mellitus （ OR = 3.71,95% CI 1.09 - 12. 56, P = 0. 035 ） were significantly correlated with the decrease of SKGFR, but not RAS, sex, smoking, hypertension, and coronary ar- tery disease. Conclusion Functions in paired kidneys with and without RAS are similar, but occlusion and RAS with atro- phy are associated the significant reduction in kidney function compared to the contralateral kidney.