张欣,王梅,左力,杨敏,邹英华

• 1:北京大学第一医院肾脏内科
• 2:北京大学人民医院肾脏内科
• 3:放射介入与血管外科

摘要(Abstract)：

目的评价支架术对动脉粥样硬化性肾动脉狭窄(ARAS)患者肾功能的长期影响。方法56例单侧或双侧肾动脉狭窄程度≥70%的ARAS患者行肾动脉支架术。患者于术后1个月及以后每3~6个月随访一次,记录血压、血肌酐及降压药物剂量。使用中国公式计算估测肾小球滤过率(eGFR),并评价24个月时血压、肾功能的改善与获益率。结果平均随访33.8±10.5(24~54)个月。(1)血压在术后1个月即明显下降,术后24个月时进一步下降(SBP 129.1±12.9 mmHg比139.2±17.5 mmHg;DBP 72.6±7.1 mmHg比80.6±12.8 mmHg,P均<0.01)。高血压治愈率6.7%,改善率31.0%,获益率37.7%。(2)SCr与GFR在随访过程中保持稳定,24个月时与基线相比无明显变化[(SCr 125.8±64.4μmol/L比124.3±52.1μmol/L;eGFR59.3±18.9 mL/(min.1.73m2)比60.8±23.0 mL/(min.1.73 m2),P均>0.05]。肾功能改善率9.3%,稳定率62.9%,获益率72.2%。(3)Logistic回归分析显示,男性与糖尿病是肾功能恶化的独立危险因素(OR=11.1,5.88;P均<0.05)。肾动脉狭窄程度与肾功能预后不相关。结论支架治疗使肾功能稳定。肾动脉狭窄程度不影响肾功能预后。男性、糖尿病是肾功能恶化的独立危险因素。

关键词(KeyWords)： 肾动脉梗阻;动脉粥样硬化;支架;肾小球滤过率

Abstract:

Keywords:

基金项目(Foundation): 卫生部临床学科重点项目(20010913)

作者(Author): 张欣,王梅,左力,杨敏,邹英华

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