肾动脉狭窄患者长期肾功能改善的影响因素探讨

Factors influencing the long-term improvement of renal function in patients with renal artery stenosis

目的探讨肾动脉狭窄(RAS)患者治疗后长期肾功能改善的影响因素。方法回顾性分析2015年3月至2020年5月于北京安贞医院经肾动脉造影术诊断肾动脉狭窄≥75%且血肌酐≤221μmol/L的85例患者的临床资料。随访≥12个月,估算肾小球滤过率(eGFR)较治疗前升高≥10%为肾功能改善组(30例),余为肾功能未改善组(55例)。多因素Cox回归分析患者长期肾功能改善的影响因素。结果62例(72.9%)行肾动脉支架置入,30例(35.3%)肾功能改善。超声造影检测显示,肾功能改善组患肾血流低灌注的比率显著低于未改善组,差异有统计学意义(36.7%对61.8%,P=0.026)。多因素Cox回归分析显示无论是否行肾动脉支架置入,患肾内血流非低灌注和年龄(<65岁)是长期肾功能改善的独立影响因素(HR 2.46,95%CI 1.14~5.31,P=0.022;HR 2.83,95%CI 1.15~6.99,P=0.024)。行肾动脉支架置入的62例患者,最后随访时血压及降压药种类较术前显著减少,差异有统计学意义(P<0.05),血肌酐较术前差异无统计学意义(P>0.05)。多因素Cox回归分析显示,支架侧肾内血流非低灌注和年龄(<65岁)是行支架置入后长期肾功能改善的独立影响因素(HR 2.65,95%CI 1.09~6.41,P=0.031;HR 3.55,95%CI 1.18~10.69,P=0.024)。结论评估肾内血流灌注并结合临床其他指标判断RAS患者是否行支架置入治疗,有助于长期肾功能的改善。

Objective To explore the factors influencing the long-term improvement of renal function in patients with renal artery stenosis(RAS).Methods The clinical data of 85 patients with serum creatinine≤221μmol/L and renal artery stenosis≥75%diagnosed by digital subtraction angiography from March 2015 to May 2020 in Beijing Anzhen Hospital were retrospectively analyzed.All patients were followed up for more than 12 months.Patients with the estimated glomerular filtration rate(e GFR)increased by≥10%compared with that before treatment were divided into the renal function improvement group(30 cases)and the rest were the renal function no-improvement group(55 cases).Multivariate Cox regression analysis was used to analyze the influencing factors of long-term improvement of renal function.Results Totally62(72.9%)patients underwent renal artery stenting,and 30(35.3%)patients had improved renal function.The results of contrast-enhanced ultrasonography showed that the rate of renal blood hypoperfusion in the improved renal function group was significantly lower than that in the non-improved group(36.7%vs.61.8%,P=0.026).Multivariate Cox regression analysis indicated that non hypoperfusion of renal blood flow in the affected side and age(<65 years)were independent influencing factors of long-term renal function improvement whether renal artery stenting was performed or not(HR 2.46,95%CI 1.14-5.31,P=0.022;HR 2.83,95%CI 1.15-6.99,P=0.024).The blood pressure level and types of antihypertensive drugs in 62 patients undergoing renal artery stenting were significantly lower than those before operation(P<0.05),while there was no significant difference in serum creatinine(P>0.05).Multivariate Cox regression analysis showed that non hypoperfusion of renal blood flow on the stent side and age(<65years)were independent influencing factors of longterm renal function improvement after stent implantation(HR 2.65,95%CI 1.09-6.41,P=0.031;HR 3.55,95%CI 1.18-10.69,P=0.024).Conclusions It is helpful in improving long-term renal function to make evaluation of intrarenal blood perfusion and combination with other clinical indexes to judge whether RAS patients are treated with stent implantation.