经皮肾动脉支架置入术与单纯药物对粥样硬化性肾动脉狭窄患者预后影响

Effects of percutaneous renal artery stent implantation and drug therapy alone on the prognosis of patients with atherosclerotic renal artery stenosis

目的探讨单中心行经皮肾动脉支架置入术(PTRAS)与单纯药物治疗对粥样硬化性肾动脉狭窄(ARAS)患者短期预后的影响。方法选取北部战区总医院心血管内科自1994年3月至2016年11月收治的238例ARAS患者为研究对象。根据治疗方式不同将患者分为PTRAS组(n=131)与单纯药物组(n=107)。记录并比较两组患者治疗1年后与治疗前收缩压、舒张压、肾小球滤过率(eGFR)改善的差值。比较两组患者终点事件发生率。结果 PTRAS组治疗前后收缩压、舒张压及eGFR差值均大于单纯药物组,两组间比较,差异均有统计学意义(P<0.05)。两组患者源性的复合终点(PoCE)发生率比较,差异无统计学意义(P>0.05);单纯药物组主要不良心血管事件(MACE)的发生率显著高于PTRAS组,两组间比较,差异有统计学意义(P<0.05)。结论与单纯药物治疗比较,PTRAS可减少短期MACE的发生率,但不能有效改善收缩压、舒张压、eGFR及PoCE发生率。

Objective To investigate the effect of single-center percutaneous renal artery stent implantation(PTRAS)and drug therapy alone on short-term prognosis of patients with atherosclerotic renal artery stenosis(ARAS).Methods A retrospective study was performed on 238 cases of patients with ARAS who were admitted from March 1994 to November 2016.Patients were divided into the PTRAS group(n=131)and pure drug group(n=107)according to different treatment methods.The differences in systolic blood pressure,diastolic blood pressure and glomerular filtration rate(eGFR)between the two groups after 1 year of treatment and before treatment were recorded and compared.The incidence of endpoint events was compared between the two groups.Results Compared with the single drug group,the difference of systolic blood pressure,diastolic blood pressure and eGFR before and after treatment in the PTRAS group was greater than that in the single drug group,and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in the incidence of patient-oriented composite endpoint(PoCE)between the two groups(P>0.05).The incidence of major adverse cardiovascular events(MACE)in the single drug group was significantly higher than that in the PTRAS group(P<0.05).Conclusion Compared with drug therapy alone,PTRAS can reduce the incidence of short-term MACE,while cannot effectively improve the systolic blood pressure,diastolic blood pressure,eGFR or incidence of PoCE events.