大动脉炎合并肾动脉受累的临床分析

Clinical analysis of renal artery involvement inTakayasu's arteritis patients

目的分析大动脉炎合并肾动脉受累的临床特征及相关因素。方法收集105例大动脉炎患者的临床资料,对合并和未合并肾动脉受累患者进行比较,应用t检验、Sperman相关分析等方法进行分析。结果肾动脉受累组较非肾动脉受累组易出现高血压[76%(16/21)和25%(21/84);χ^2=19.291,P<0.01]、晕厥[19%(4/21)和4%(3/84),P=0.028]、头痛[52%(11/21)和25%(21/84);χ2=5.944,P=0.019],颈部疼痛[0(0/21)和26%(22/84),P=0.006]少于非肾动脉受累组。合并肾动脉受累者,肌酐更高[(67±30)mmol/L和(50±14)mmol/L;t=2.436,P=0.023],CD3+[1299(1261.5,1313.45)个/μl和1531(1330,1559.5)个/μl;Z=-3.12,P=0.002]、CD4+[793.6(715,804.32)个/μl和914.88(794.3,914.8)个/μl;Z=-2.597,P=0.009]、CD8+[451.09(451.09,489.5)个/μl和552.39(459.75,557.5)个/μl;Z=-3.271,P=0.001]淋巴细胞亚群较低。肾动脉受累组主动脉内径[(33±5)mm和(30±4)mm,t=2.62,P=0.01]、左心房内径[(35±4)mm和(32±4)mm;t=3.065,P=0.003]等大于非肾动脉受累组。肾动脉受累易同时合并腹主动脉(χ2=14.292,P<0.01)、髂总动脉(P=0.005)等受累,而颈总动脉(χ2=3.815,P=0.047)、锁骨下动脉(P=0.022)受累较少。大动脉炎患者肌酐水平与肾动脉受累的发生呈正相关(r=0.282,P=0.004),淋巴细胞亚群数量(CD3、CD4、CD8)与其呈负相关(r=-0.306,P=0.002;r=-0.255,P=0.009;r=-0.321,P=0.001)。结论大动脉炎合并肾动脉受累易出现高血压、晕厥、头痛症状,心、肾功能更差,淋巴细胞亚群较低,易同时合并腹主动脉等血管受累,应尽早评估及治疗。

Objective To investigate the clinical features and influencing factors of renal artery involvement in patients with Takayasu's arteritis(TA).Methods One hundred and five TA patients were included and their clinical features,laboratory tests,echocardiographic findings were collected and analyzed.The t-test,Mann-Whitney U test,Sperman's correlation and logistic regression were used for statistical analysis.Results Of the 105 patients with Takayasu's arteritis,21(20%)patients were diagnosed to have renal artery involvement.They had higher frequency of hypertension[76%(16/21)vs 25%(21/84);χ^2=19.291,P<0.01],syncope[19%(4/21)vs 4%(3/84);P=0.028]and headache[52%(11/21)vs 25%(21/84);χ2=5.944,P=0.019].Patients with renal artery invol-vement had higher levels of creatinine[(67±30)mmol/L vs(50±14)mmol/L;t=2.436,P=0.023],lower levels of lymphocyte subsets CD3+[1299(1261.5,1313.45)/μl vs 1531(1330,1559.5)/μl;Z=-3.12,P=0.002],CD4+[793.6(715,804.32)/μl vs 914.88(794.3,914.8)/μl;Z=-2.597,P=0.009],CD8+[451.09(451.09,489.5)/μl vs 552.39(459.75,557.5)/μl;Z=-3.271,P=0.001]and glomerular filtration rate(Z=-2.612,P=0.009).Comparison of echocardiographic parameters between the two groups showed that the diameters of left atrium[(35±4)mm vs(32±4)mm;t=3.065,P=0.003]and end-diastolic left ventricular[49.2(47.5,52.5)vs 45.84(43.25,47.75);Z=-3.795,P<0.01]were larger in renal artery involvement group.Abdominal aorta(χ2=14.292,P<0.01),superior mesenteric artery(P<0.01),inferior mesenteric artery(P=0.038)and common iliac artery(P=0.005),were more likely involved in patients with renal artery involvement;while the common carotid artery(χ2=3.815,P=0.047)and subclavian artery(P=0.022)were less affected.There was a positive correlation between creati-nine level(r=0.282,P=0.004)and renal artery involvement in patients with arteritis,and the number of lymphocyte subsets(CD3,CD4,CD8)(r=-0.306,P=0.002;r=-0.255,P=0.009;r=-0.321,P=0.001)was negatively correlated with renal artery involvement.Conclusion The most common pattern of renal artery involvement is stenosis and occlusion.Hypertension,syncope,headache,kidney dysfunction and heart failure are more prevalent among patients with renal artery involvement.The number of lymphocyte subsets is low,and involvement of abdominal aorta is common.It should be assessed and treated as soon as it is discovered.