肾动脉支架置入术联合规范药物治疗对粥样硬化性肾动脉狭窄患者的疗效

摘要

Objective: To evaluatethe efficacy of renal artery stenting combining optimal drug therapy in patients with atherosclerotic renal artery stenosis. Methods:This is a prospective cohort study for patients who received percutaneous renal artery stenting in our hospital from 2011-09 to 2013-03. All patients had conifrmed diagnosis of atherosclerotic renal artery stenosis combing hypertension and/or renal functional damage. Thepatients received optimal drug therapy for anti-platelet and blood pressure, lipids, glucose controlling, and they were followed-up for at least 12 months to observe the improvement of blood pressure and renal function. Results:There were 149 patients at the mean age of (61.54 ± 9.63) years and 185 renal artery stenosis with stent implantation;the average stenosis rate was (83.11±7.30)%and the success rate of operation was 99.32%(148/149). During follow-up period, the patients had increased estimated glomerular ifltration rate (GFR) compared to base line from (76.49 ± 22.50) ml/(min·1.73 m2) to (84.09 ± 28.79) ml/(min·1.73 m2), P<0.05 and decreased 24 h urinary protein from 0.1(IQR 0.02, 0.5) g to 0.04 (IQR0.01, 0.11)g, P<0.001;less type of drug therapy for hypertension from 2.22 to 1.56, P<0.05, decreased clinical and 24h dynamic systemic/diastolic blood pressure from (153.4 ± 15.6)/(83.77 ± 12.60) mmHg to (134.6 ± 14.4)/(73.57 ± 9.12) mmHg and from (143.32 ± 19.87)/(80.51 ± 11.33) mmHg to (124.44 ± 14.90)/(69.09 ± 9.49) mmHg, all P<0.05. Conclusion:Renal artery stenting combining optimal drug therapy may improve blood pressure controlling and renal function in strictly selected patients with atherosclerotic renal artery stenosis.%目的：评估肾动脉支架置入术联合规范药物治疗对伴有功能意义的粥样硬化性肾动脉狭窄患者的临床疗效。　　方法：本研究为前瞻性队列研究，研究对象为2011-09至2013-03于我院行肾动脉支架置入术的患者。所有患者均符合动脉粥样硬化性肾动脉狭窄的诊断并伴有导致高血压和（或）肾功能损害的功能意义，接受规范的抗血小板、降压、调脂、降糖等药物治疗，使血压、血脂和血糖达标。随访至少12个月，观察肾动脉支架置入术对患者血压和肾功能的影响。　　结果：入组149例粥样硬化性肾动脉狭窄患者，平均年龄（61.54±9.63）岁。共185条肾动脉行经皮肾动脉支架置入术，平均狭窄率为（83.11±7.30）%，手术成功率为99.32%（148/149）。12个月随诊时，患者估算肾小球滤过率较基线明显升高（P<0.05），从（76.49±22.50）ml/（min·1.73 m2）升至（84.09±28.79）ml/（min·1.73 m2）；24 h尿蛋白较基线明显下降（P<0.001），从[0.1（四分位间距0.02，0.5）g]降至[0.04（四分位间距0.01，0.11）g]；服用降压药种类较基线时明显减少，从2.22种减至1.56种（P<0.05）；诊室血压及24 h动态血压较基线时明显下降（P均<0.05），诊室收缩压/舒张压由（153.4±15.6）/（83.77±12.60）mmHg（1 mmHg=0.133 kPa）降至（134.6±14.4）/（73.57±9.12）mmHg，24 h平均收缩压/舒张压由（143.32±19.87）/（80.51±11.33）mmHg降至（124.44±14.90）/（69.09±9.49）mmHg。　　结论：该研究显示，在严格筛选的粥样硬化性肾动狭窄患者中，肾动脉支架置入术联合规范药物治疗可改善血压和肾功能。