影响肾动脉支架置入术后肾功能改善的相关因素及预测价值

Relevant Factors and Predictive Value of Renal Function Improvement after PTRAS for Renal Artery Stenosis

目的:探讨经皮腔内肾动脉支架置入术(PTRAS)对改善肾动脉狭窄(RAS)患者肾功能的相关因素,评估各指标预测术后肾功能改善的价值。方法:回顾性分析65例RAS患者支架术后的临床资料。以术后3月血浆肌酐清除率(CCr)升高大于15%作为判断疗效的指标,并以此分为疗效优良组和疗效欠佳组。采用单因素筛选和Logistic回归分析患者性别、年龄、冠心病史、高血压病史、糖尿病史、单双侧肾动脉狭窄、肾动脉狭窄程度、术前病肾长径与术前CCr比值、术前尿蛋白定性、术前肾素水平及术前血压等可能影响肾功能改善的因素,并应用受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价各指标对支架术后改善肾功能的价值。结果:单因素分析显示影响术后肾功能改善的因素有糖尿病史、术前病肾长径与术前CCr比值(P<0.05);Logistic回归分析表明糖尿病史与术前病肾长径与术前CCr比值对术后肾功能改善的影响有统计学意义(P<0.05);术前病肾长径与术前CCr比值ROC曲线面积为0.728(95%CI:0.586-0.871,P=0.003),其界值为1.62,敏感度0.866,特异度0.629。结论:肾动脉狭窄患者糖尿病史、术前病肾长径与术前CCr比值是肾动脉支架术后肾功能改善的影响因素;术前病肾长径与术前CCr比值可预测PTRAS后肾功能的改善。

Objective:This study intended to examine the factors associated with percutaneous transluminal renal artery stenting(PTRAS)in enhancing renal function among patients with renal artery stenosis(RAS)and to assess the predictive value of each metric regarding post-operative renal function improvement.Methods:A retrospective analysis was made with regards to the clinical data of 65 RAS patients who underwent stenting.The criterion for assessing treatment effectiveness was an increase in plasma creatinine clearance rate(CCR)by over 15%within three months'post-operation.Based on this,patients were categorized into two groups:those with significant treatment effectiveness and those with insignificant treatment effectiveness.Both univariate screening and logistic regression were employed to examine potential factors influencing renal function improvement,including gender,age,coronary heart disease history,hypertension history,diabetes mellitus history,unilateral versus bilateral renal artery stenosis,the degree of renal artery stenosis,the ratio of preoperative diseased kidney length and diameter to preoperative CCR,preoperative urinary protein characteristics,preoperative renin levels and preoperative blood pressure.The receiver operating characteristic(ROC)curve was utilized to determine the area under the curve(AUC)and evaluate the significance of each metric in predicting post-stenting renal function improvement.Results:Univariate analysis revealed that diabetes mellitus history and the ratio of preoperative diseased kidney length to preoperative CCR were factors influencing post-operative renal function improvement(P<0.05).Logistic regression analysis further confirmed the statistical significance of these two factors(P<0.05).The ROC curve analysis for the ratio of preoperative diseased kidney length to preoperative CCR yielded an AUC of 0.728(95%CI:0.586-0.871,P=0.003)with a cut-off value of 1.62,a sensitivity of 0.866,and a specificity of 0.629.Conclusion:Among patients with renal artery stenosis,diabetes mellitus history and the ratio of preoperative diseased kidney length and diameter to preoperative CCR emerge as influential factors in renal function improvement following renal artery stenting.In addition,the ratio of preoperative diseased kidney length to preoperative CCR demonstrates potential in predicting renal function improvement after PTRAS.