伴有高血压的缺血性脑血管病患者肾动脉狭窄的相关性研究

Risk factors for atherosclerotic renal artery stenosis in cerebral ischemic vascular disease patients with hypertension

目的通过血管造影评估伴有高血压的缺血性脑血管病患者动脉粥样硬化性肾动脉狭窄(ARAS)患病率及其相关危险因素。方法选择老年高血压患者274例,在实施脑血管造影时,同时行非选择性肾动脉造影以评价肾动脉主干狭窄(数字减影血管造影术测量直径狭窄率≥50%)患病率。根据诊断分为ARAS组51例,无ARAS组223例。采用标准化问卷法收集人口学资料、心脏病、吸烟、糖尿病、高脂血症、脑梗死、心脑血管病家族史等临床资料,通过单因素及多因素分析伴有高血压的老年缺血性脑血管病患者ARAS的相关因素。结果274例患者中,吸烟87例(31.8%),糖尿病98例(35.8%),高脂血症126例(46.0%),脑梗死122例(44.5%),慢性肾功能不全23例(8.4%),心脑血管病家族史79例(28.8%);单侧ARAS 42例(15.3%)、双侧ARAS 9例(3.3%)。ARAS组吸烟比例明显高于非ARAS组,差异有统计学意义(96.1%vs 17.0%,P=0.001)。结论对拟行脑血管造影的高血压患者建议同时行非选择性肾动脉造影,尤其是吸烟的高血压患者发现肾动脉主干狭窄的可能性更大。

Objective To assess the risk factors for ARAS in cerebral ischemic vascular disease patients with hypertension by angiography.Methods Two hundred and seventy-four elderly hypertension patients were divided into ARAS group(n=51)and ARAS-free group(n=223)according to their cerebral angiography and DSA.The demographic data,incidence of heart disease,DM,hyperlipidemia,cerebral infarction,cardiocerebrovascular disease and history of smoking were recorded with standardized questionnaires.The risk factors for ARAS in cerebral ischemic vascular disease patients with hypertension were analyzed by univariate logistic regression analysis and multivariate logistic regression analysis respectively.Results Of the 274 patients included in this study,87(31.8%)had a history of smoking,79(28.8%)had a family history of cardiocerebrovascular diseases,and 98(35.8%),126(46.0%),122(44.5%),23(8.4%),42(15.3%)and 9(3.3%)were diagnosed with DM,hyperlipidemia,cerebral infarction,chronic renal insufficiency,unilateral ARAS and bilateral ARAS respectively.The rate of smoking was significantly higher in ARAS group than in ARAS-free group(96.1%vs 17.0%,P=0.001).Conclusion Non-selective renal arteriography is recommended for hypertension patients who are going to undergo cerebral angiography,especially for smoking hypertension patients as they are more likely to have ARAS.