肾动脉支架置入术治疗老年粥样硬化性肾动脉狭窄的研究Clinical outcome of percutaneous transluminal renal angioplasty with stent implantation in elderly
赵佳慧,程庆砾,马媛,张晓英,叶平
摘要(Abstract)：
目的回顾性研究老年动脉粥样硬化性肾动脉狭窄(ARAS)患者行经皮腔内肾动脉支架置入术(PTRAS)的临床疗效。方法选择2003年1月至2006年3月在解放军总医院经肾动脉造影确诊为ARAS、肾动脉面积狭窄≥70%、年龄≥65岁病例,分为治疗组(35例,行PTRAS术治疗)和对照组(8例,给予药物治疗)。统计分析两组血压、肾功能的变化趋势和PTRAS术后支架内再狭窄发生率。结果治疗组行PTRAS术后3天血压明显下降[术前(155.4±24.8)/(79.4±10.8)mmHg比术后(126.8±10.9)/(67.3±8.9)mmHg;P<0.01),术后12个月血压[(134.6±15.5)/(68.6±7.4)mmHg]仍明显低于术前(P<0.01),至术后24个月时血压回升,逐渐接近术前水平。治疗组口服降压药物的种类术后明显减少(术前2.6±1.0种比术后6个月1.9±0.9种;P<0.01),但术后12个月以后用药种类开始增加,接近术前水平。对照组在肾动脉造影术后12个月内血压水平及口服降压药物种类均较造影前无显著变化。治疗组术后12个月时68.8%的患者肾功能无变化,15.6%的患者肾功能可改善,但是术后肾功能恶化的比例逐渐增加,至24个月时达到35.7%。对照组肾动脉造影术后12个月内肾功能全部为不变化。Logistic多元回归分析显示,PTRAS术后12个月时发生肾功能恶化与患者术前合并3期以上慢性肾脏病有关(P=0.005,OR=46.5),与术后采用水化治疗有关(P=0.019,OR=0.24)。治疗组PTRAS术后支架内再狭窄率为20%。多元回归分析示PTRAS术后发生支架内再狭窄与患者术前合并糖尿病有关(P=0.027,OR=47.82)。结论PTRAS术可在24个月内明显降低老年ARAS患者的血压。但是PTRAS术改善老年ARAS患者肾功能的作用有限,且存在肾功能恶化的风险。
关键词(KeyWords)： 肾动脉梗阻;动脉粥样硬化;老年人;支架
基金项目(Foundation): 解放军总医院科技创新基金老年医学项目(06LN07)
作者(Author): 赵佳慧,程庆砾,马媛,张晓英,叶平
参考文献(References)：
- [1]Hansen KJ,Edwards MS,Craven TE,et al.Prevalence of renovas-cular disease in the elderly:a population based study.J Vasc Surg,2002,36:443-451.
- [2]Standards and Practice Committee of the Society of Cardiovascular and Interventional Radiology.Guidelines for percutaneous trans-luminal angioplasty.Radiology,1990,177:619-626.
- [3]Tsao CR,Lee WL,Liu TJ,et al.Delicate Percutaneous renal ar-tery stenting minimizes postoperative renal injury and protects kidney in patients with severe atherosclerotic renal artery stenosis and impaired renal function.Int Heart J,2005,46:1061-1072.
- [4]Gill KS,Fowler RC.Atherosclerotic renal arterial stenosis:clini-cal outcomes of stent placement for hypertension and renal fail-ure.Radiology,2003,226:821-826.
- [5]Leertouwer TC,Gussenhoven EJ,Bosch JL,et al.Stent placement fo renal arterial stenosis:where do we stand?Ameta analysis.Ra-diology,2000,216:78-85.
- [6]蒋雄京,吴海英,张慧敏,等.经皮肾动脉支架术治疗肾血管性高血压的临床结果.中国循环杂志,2006,2:89-92.
- [7]Watson PS,Hadjipetrou P,Cox SV,et al.Effect of renal artery stenting on renal function and size in patients with atherosclerotic renovascular disease.Circulation,2000,102:1671-1677.
- [8]Beutler JJ,Van Ampting JM,Vande Ven PJ,et al.Long term effects of arterial stenting on kidney function for patients with os-tial atherosclerotic renal artery stenosis and renal insufficiency.J Am Soc Nephrol,2001,12:1475-1481.
- [9]Zeller T,Frank U,Muller C,et al.Stent-supported angioplasty of severe atherosclerotic renal artery stenosis preserves renal function and improves blood pressure control:long-term results from a pro-spective registry of456lesions.J Endovasc Ther,2004,11:95-106.
- [10]蒋雄京,吴海英,张慧敏,等.肾动脉支架置入对缺血性肾病患者肾功能的影响.中华医学杂志,2005,29:2046-2049.