肾动脉支架置入术对老年肾动脉粥样硬化性高血压的长期影响及临床相关因素

Long-term effects of renal artery stent implantation on elderly patients with renal atherosclerotic hypertension and related clinical factors

目的探讨肾动脉支架置入术对老年肾动脉粥样硬化性高血压的长期影响及临床相关因素。方法选取2013年5月至2015年7月淄博市人民医院收治的85例老年肾动脉粥样硬化性高血压患者作为研究对象,所有患者均接受肾动脉支架置入术治疗。术后随访3～48个月,观察研究对象舒张压(DBP)、收缩压(SBP)、血肌酐(Scr),并对肾功能恶化、全因死亡的影响因素进行分析。结果随访结束时患者DBP、SBP水平较术前降低,Scr水平较术前升高,差异有统计学意义(P <0. 05)。18例(21. 18%)出现肾功能恶化。Logistic多因素分析显示,合并糖尿病、年龄≥60岁、Scr≥133. 3μmol/L是导致肾功能恶化的独立危险因素(P <0. 05)。10例(11. 76%)死亡,其中5例死于肾功能衰竭,4例心力衰竭,1例病因尚未明确。Logistic多因素分析显示,年龄≥60岁是导致全因死亡的独立危险因素(P <0. 05)。结论肾动脉支架置入术治疗老年肾动脉粥样硬化性高血压可长期保持血压稳定,Scr≥133. 3μmol/L、年龄≥60岁、合并糖尿病是导致肾动脉支架置入术预后不良的危险因素。

Objective To investigate the long-term effect of renal artery stent implantation on elderly patients with renal atherosclerotic hypertension and related clinical factors. Methods Eighty-five elderly patients with renal atherosclerotic hypertension admitted to Zibo People’s Hospital from May 2013 to July 2015 were selected as the study subjects. All patients received renal artery stenting. The subjects were followed up for 3 to 48 months. The diastolic blood pressure( DBP),systolic blood pressure( SBP) and serum creatinine( Scr) were observed and the influencing factors of renal function deterioration and all-cause death were analyzed. Results At the end of follow-up,the levels of DBP and SBP were lower than those before operation,and the levels of Scr were higher than those before operation. The difference was statistically significant( P < 0. 05). Renal function deteriorated in 18 cases( 21. 18%). Logistic multivariate analysis showed that diabetes mellitus,age( > 60 years old) and Scr( > 133. 3 μmol/L) were independent risk factors for deterioration of renal function( P < 0. 05). Ten patients( 11. 76%) died,including 5 cases of renal failure,4 cases of heart failure,and 1 case of unknown etiology. Logistic multivariate analysis showed that age over 60 was an independent risk factor for all-cause mortality( P < 0. 05). Conclusion Renal artery stent implantation in the treatment of elderly patients with atherosclerotic hypertension can maintain blood pressure stability for a long time. Scr( > 133. 3 μmol/L),age( > 60 years old) and diabetes mellitus are risk factors leading to poor prognosis of renal artery stent implantation.