普罗布考、瑞舒伐他汀、阿司匹林联合治疗动脉粥样硬化性肾动脉狭窄的效果评价

The Effect of Probucol Combined with Rosuvastatin and Aspirin on Atherosclerotic Renal Artery Stenosis

目的观察普罗布考、瑞舒伐他汀、阿司匹林联合治疗对动脉粥样硬化性。肾动脉狭窄患者肾脏血流动力学、氧化应激和炎症反应、血脂代谢及肾功能的影响。方法选取我院肾动脉造影患者97例，根据相关标准进行筛选，共57例患者符合纳入标准。将符合纳入标准的患者随机分为两组：PRA组29例，其中男19例，女10例；RA组28例，其中男20例，女8例。RA组患者给予瑞舒伐他汀钙片10mg／d，每晚1次，阿司匹林肠溶片100mg／d，每日1次口服。PRA组在RA组的基础上加用普罗布考片500mg／次，每日2次口服。疗程6个月。两组患者治疗前后经彩色多普勒超声诊断仪测量腹主动脉、。肾动脉及叶间动脉峰值流速（PSV），计算肾动脉与腹主动脉峰值流速比率（RAR），肾动脉与叶间动脉峰值流速比率（RIR），记录肾动脉阻力指数（RI）。监测治疗前后氧化低密度脂蛋白（OX—LDL）、高敏C反应蛋白（hs—CRP）、血清肌酐（Scr）、胱抑素c（cysC）、甘油三酯（TG）、总胆固醇（TC），低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、尿微量白蛋白排泄率（UAER），并进行比较。结果治疗前两组患者的OX—LDL、hs—CRP、Scr、cysC、TG、TC、LDL、HDL和UAER值比较差异无统计学意义（P〉0．05）；6个月后两组患者组内比较，OX—LDL、hs—CRP、Scr、cysC、TG、TC、LDL和UAER值明显下降（P〈0．叭），RA组HDL值升高（P〈0．01），PRA组HDL值无明显变化（P〉0．05）；组间比较，PRA组较RA组OX—LDL、hs—CRP、Scr、cysC、TG、TC、LDL和UAER值下降更明显（P〈0．05或P〈0．01）；治疗前两组患者肾动脉及叶间动脉PSV、RAR、RIR和肾动脉RI比较无统计学差异，6个月后，两组患者组内比较，肾动脉PSV、肾动脉RI、RAR和RIR明显下降，叶间动脉PSV明显升高（P〈0．01），组间比较，PRA组上述指标改善更明显（P〈0．01）。结论普罗布考、瑞舒伐他汀、阿司匹林联合疗法（PRA疗法）与瑞舒伐他汀、阿司匹林联合疗法（RA疗法）比较，能更好的防治肾动脉粥样硬化，改善肾脏血流动力学指标，抗炎抗氧化、调节血脂代谢及保护肾功能。

Objective To observe the effects of probucol combined with rosuvastatin and aspirin on renal hemo- dynamics,oxidative stress, inflammatory response, blood lipid metabolism and renal function in patients with athero- sclerotic renal artery stenosis. Methods 97 patients undergoing renal arteriography in our hospital were chose and 57 of them were in accordance with the inclusive criteria. They were divided into 2 groups randomly：PRA group（ 29 pa- tients,19 male and 10 female）and RA group（28 patients,20 male and 8 female）. Patients in RA group were treated with rosuvastatin 10 mg/d（qn） ,aspirin 100 mg/d（ once daily,oral）. Patients in PRA group were given probucol 500 mg additionally（ twice daily）. The course of treatment last for 6 months. The peek systolic velocity（PSV） in abdominal aorta, renal artery and interlobar artery were measured by color doppler imaging before and after treatment. RAR, RIR and renal artery resistance index （RI） were calculated and recorded, ox - LDL, hs - CRP, Scr, cysC, TG, TC, LDL, HDL and UAER were observed and compared. Results There was no significant difference in ox - LDL, hs - CRP, Scr, cysC,TG,TC, LDL, HDL and UAER between two groups before treatment（ P 〉 0.05 ）. 6 month later, ox - LDL, hs - CRP, Scr, cysC, TG,TC, LDL and UAER in the two groups were lower compared with those before treatment（P 〈 0.01 ）. HDE in RA group was higher （ P 〈 0.01 ） ,while it showed no obvious changes in PRA group （ P 〉 0.05 ）. ox - LDL, hs - CRP, Scr, cysC,TG,TC, LDL and UAER in PRA group decreased significantly compared with those in RA group（ P 〈0.01 or P 〈0.05 ）. There was no significant difference in renal artery and interlobar artery PSV,renal ar- tery RI, RAR and RIR between two groups before treatment （ P 〉 0.05 ）. 6 month later, renal artery PSV, RI, RAR and RIR decreased and interlobar artery PSV increased significantly in two groups compared with those before treatment（ P 〈 0.01 ）. The indexs above changed more obviously in PRA group than those in RA group（ P 〈 0.01 ）. Conclusion Probucol combined with rosuvastatin and aspirin（PRA therapy）can prevent renal atherosclerosis, ameliorate renal hemodynamics index, prevent oxidative stress and inflammatory response, modulate blood lipid metabolism and protect re- nal function better.