胱抑素C和Stevens-Cr 方程估算eGFR早期诊断造影剂肾病

目的：经皮冠状动脉介入治疗前后，测定血清胱抑素C、经Stevens-Cr方程估算出肾小球滤过率，观察其早期诊断造影剂肾病的临床意义。方法：选取在我院行PCI的患者256例，其中22例于术后出现造影剂肾病，设为CIN组，其余234例患者设为对照组，分别于术前及术后12h、24h、48h检测血肌酐、血清胱抑素C，经简化MDRD方程、Stevens-Cr方程估算肾小球滤过率，进行比较。结果：术前CIN组肌酐、血清胱抑素C，经简化MDRD方程、Stevens-Cr方程估算出的肾小球滤过率与对照组相比较差异无统计学意义（P﹥0.05）。术后24h CIN组患者血肌酐水平开始升高，经简化MDRD方程估算出的肾小球滤过率减低明显，于术前及对照组相比较差异有统计学意义（P＜0.01）。术后12h CIN组患者血清胱抑素C水平开始升高，经Stevens-Cr 方程估算出的肾小球滤过率减低明显，与术前及对照组相比较差异有统计学意义（P＜0.05）。结论：血清胱抑素C、经Stevens-Cr方程估算出的肾小球滤过率可以反映早期肾功能损害的严重程度，可以作为造影剂肾病的检测指标。     

血清胱抑素C在2型糖尿病不同肾损害期的变化及其临床意义

目的探讨血清胱抑素C在2型糖尿病不同肾损害期的变化及其临床意义,比较血清胱抑素C与肾小球滤过率、尿微量白蛋白排泄率间的相关性。方法采用颗粒增强散射免疫比浊法测定102例2型糖尿病患者(其中并糖尿病肾病66例)血清胱抑素水平,同时测定肾小球滤过率和尿微量白蛋白排泄率。结果2型糖尿病正常白蛋白尿组,2型糖尿病微量白蛋白尿组及2型糖尿病大量白蛋白尿组间血清胱抑素C水平均有显著差异(P<0.01),2型糖尿病微量白蛋白尿组和2型糖尿病大量白蛋白尿组血清胱抑素C测值与肾小球滤过率有良好的相关性(P<0.05)。结论血清胱抑素C在临床上可作为肾小球滤过率的判断指标,且有助于2型糖尿病肾病的早期诊断。     

血清胱抑素C在高血压早期肾损伤中的诊断价值

目的探讨血清胱抑素C（Cystain C）水平在原发性高血压早期肾损伤中的临床诊断价值。方法选择我院收治的高血压1～2级患者共78例作为观察组,同时选择79例健康体检者作为对照组,分别检测两组治疗前后Cystain C、24h尿清蛋白定量、血清肌酐（Scr）、内生肌酐清除率（Ccr）等。结果两组SBP、DBP、血清胱抑素C、24h尿清蛋白定量、内生肌酐清除率间差异有统计学意义（P〈0．01）,血清肌酐间差异无统计学意义（P〉0．05）。观察组中Cystain C与24h尿清蛋白定量、血清肌酐、内生肌酐清除率有较好的相关性,并且血清胱抑素C与尿清蛋白定量的相关性优于Scr、Ccr的相关性,并与尿清蛋白定量、血清肌酐方向一致。结论血清Cystain C的浓度比Scr浓度更能够反映肾小球滤过功能的损害,是早期诊断肾小球滤过功能受损的敏感指标。     

胱抑素C和心血管疾病危险因素的关系

半胱氨酸蛋白酶抑制剂（简称胱抑素C）是评价肾小球功能-肾小球滤过率最理想的指标之一。目前发现,胱抑素C与心血管疾病的发生及预后有密切关系。现就胱抑素C与心血管疾病危险关系的相关性做以下综述。     

血清胱抑素C在肾损伤患者中的应用

血清胱抑素C是被认为可能取代血清肌酐的新肾小球滤过率标志物,本文针对近几年血清胱抑素C在各种肾损伤患者研究中的进展作一综述。     

探讨胱抑素C在早期糖尿病肾病中的应用价值

目前临床上常用血肌酐（Scr），肌酐清除率（Ccr）来反映肾小球滤过功能，都有一定的局限性，且不同程度地受一些肾内。肾外因素的影响。近年国外已有多篇报道认为胱抑素C可较敏感地反映肾小球滤过功能，本文通过比较血清Scr、Ccr、胱抑素C之间的相关性，旨在探讨胱抑素C在早期糖尿病。肾病中的应用价值。     

替比夫定联合胸腺肽-α1治疗慢性乙型肝炎临床观察

目的观察替比夫定联合胸腺肽-α1治疗慢性乙型肝炎52周的临床疗效。方法应用替比夫定联合胸腺肽-α1治疗慢性乙型肝炎患者30例,另30例只接受替比夫定治疗,观察52周。结果在治疗52周结束时,替比夫定联合胸腺肽-α1治疗患者血清HBVDNA阴转率、血清HBeAg阴转率、血清HBeAg／抗-HBe转换率和血清ALT复常率分别为50．0％、53．3％、40．O％和86．7％,而对照组则分别为23．3％（P〈O．05）、26．7％（P〈0．05）、16．7％和63．3％（P＜0．05）。结论替比夫定联合胸腺肽-α1治疗慢性乙型肝炎52周,其疗效优于替比夫定单药治疗。     

核苷(酸)类似物对慢性乙型病毒性肝炎患者肾小球滤过率的影响

目的 比较核苷(酸)类似物抗病毒治疗前后对肾小球滤过率的影响,分析可能的影响因素.方法 以慢性乙型肝炎患者为研究对象,分为恩替卡韦治疗组(0.5 mg/d)、阿德福韦酯治疗组(10 mg/d)和替比夫定治疗组(600 mg/d).观察抗病毒治疗52周后各组肾小球滤过率(GFR)的变化,并进行3组患者治疗前后HBeAg血清学转换率、GFR升高≥10mL/(min·1.73 m2)及治疗后GFR≥90 mL/(min· 1.73 m2)的比较,以及出现HBeAg血清学转换患者治疗前后GFR的比较.结果 替比夫定组在治疗52周后GFR升高(P＜0.05);治疗前后GFR升高≥10 mL/(min·1.73 m2)的患者比例替比夫定组优于阿德福韦酯组(P＜0.05).结论 替比夫定抗病毒治疗后慢性乙型肝炎患者GFR得到改善.     

胱抑素C在心血管疾病中的作用

胱抑素C浓度相对稳定,受年龄、性别和体重的影响很少,被认为是评价肾小球滤过率潜在的血清标志物。但是,近年来研究显示血清胱抑素C浓度与心血管事件密切相关,胱抑素C可能参与了动脉粥样硬化和动脉瘤等心血管疾病的发生和发展。     

重组人脑利钠肽在心衰治疗中对肾功能影响的研究

目的 观察重组人脑利钠肽在治疗心衰中对肾功能的影响.方法 回顾性分析在我院住院诊断为心衰的患者75例,随机分为两组：rhBNP组35例,在常规治疗的基础上加用rhBNP;常规治疗组40例,给予常规治疗.重组人脑利钠肽按0.0075 μg＆#183;kg-1＆#183;min-1微量泵静脉泵入,每天1次,每次持续约10 h,7d为一疗程,分别记录治疗前和7d后患者的24h尿量、尿素氮、血清肌酐、血清胱抑素、肾小球滤过率及NT-proBNP的变化.结果 治疗后与常规治疗组比较,rhBNP组的总有效率（94.3％比62.5％）、24 h尿量[（965.34±171.81）ml比（785.27±143.45）ml]、尿素氮[（7.42±2.33）mmol/L比（12.89±3.16）mmol/L]、血清肌酐[（91.53±8.21） μmol/L比（232.68±68.95） μmol/L]、血清胱抑素C[（1.55±0.11）mg/L比（3.25±1.87）mg/L],24h肌酐清除率[（45.2±5.6）ml/min比（34.1±2.6）ml/min]、NT-proBNP[（1516.43±431.52）pg/ml比（3451.1±1314.2）pg/ml]差异均有统计学意义（P＜0.05）.结论 重组人脑利钠肽在心衰患者治疗中疗效安全有效,并能改善肾功能.     

Impact of Nucleos(t)ide Analogue Combination Therapy on the Estimated Glomerular Filtration Rate in Patients With Chronic Hepatitis B

Monotherapy with telbivudine or adefovir can affect estimated the glomerular filtration rate (eGFR). However, only a few studies have assessed changes in eGFR in patients who have chronic hepatitis B (CHB) and are receiving nucleos(t)ide analogue (NA) combination therapy. In our study, we aimed to evaluate the effects of long-term NA combination therapy on eGFR in Chinese CHB patients.This retrospective study included 195 CHB patients. Patient subgroups included those treated with lamivudine plus adefovir (n = 73), telbivudine plus adefovir (n = 51), and entecavir plus adefovir (n = 35); untreated patients (n = 36) served as a control group.After an average follow-up duration of 24 months with combination therapy, analysis of changes in eGFR from baseline values, calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) formulas, showed decrease by11.08 and 18.34 mL/min (P < .001), respectively, in the lamivudine plus adefovir group; decrease by 3.73 and 10.04 mL/min (P = .012), respectively, in the entecavir plus adefovir group; and increase by 0.91 and 2.12 mL/min (P = .46), respectively, in the telbivudine plus adefovir group. The eGFR in the telbivudine plus adefovir group was similar to that for the untreated group. The eGFR decreases due to adefovir therapy could be rescued by adding telbivudine, and the eGFR increase due to telbivudine could be compromised by adding adefovir.Adefovir in combination with lamivudine or entecavir therapy was significantly associated with decreased eGFR, but telbivudine could rescue the eGFR decrease that results from adefovir treatment.     

Telbivudine vs tenofovir in hepatitis B e antigen-negative chronic hepatitis B patients: OPTIMA roadmap study

AIM To make efficacy and safety comparison of telbivudineraodmap and tenofovir-roadmap in hepatitis B e antigen(HBe Ag)-negative chronic hepatitis B(CHB) patients.METHODS This was the first prospective, randomised, two-arm, open-label, non-inferiority study in HBe Ag-negative CHB patients that compared telbivudine and tenofovir administered as per roadmap concept. Patients were treated up to 24 wk and, depending on virologic response, continued the same therapy or received addon therapy up to 104 wk. Eligible patients received an additional 52 wk of treatment in the extension period(i.e., up to 156 wk). Patients who developed virologic breakthrough(VB) while on monotherapy also received add-on therapy. The primary efficacy endpoint was the rate of patients achieving hepatitis B virus(HBV) DNA 300 copies/m L at week 52. Secondary efficacy endpoints included the rates of HBV DNA 300 and 169 copies/m L, HBV DNA change from baseline, alanine aminotransferase normalisation, hepatitis B surface antigen(HBs Ag) loss, HBs Ag seroconversion, VB, and emergence of resistance at various timepoints throughout the study. Safety and estimated glomerular filtration rate(e GFR) were also analysed.RESULTS A total of 241 patients were randomised. Non-inferiority of telbivudine arm to tenofovir arm was demonstrated at week 52(± 7 d window), with over 91% of patients in each treatment arm achieving HBV DNA level 300 copies/m L. Both arms were similar in terms of key secondary efficacy variables at weeks 104 and 156. The percentage of patients achieving HBV DNA 300 copies/m L remained high and was similar in the telbivudine and tenofovir arms at both weeks 104 and 156. Over 82% of patients in both arms achieved alanine aminotransferase normalisation at week 52, and this percentage remained high at weeks 104 and 156. Telbivudine treatment progressively reduced serum HBs Ag levels from baseline while no change was reported in quantitative HBs Ag during therapy with tenofovir. Both treaments showed acceptable safety profiles. The telbivudine arm showed e GFR improvement unlike the tenofovir arm.CONCLUSION Efficacy was shown for both telbivudine-roadmap and tenofovir-roadmap regimens in HBe Ag-negative CHB patients over 156 wk. Telbivudine arm was associated with renal improvement.     

阿德福韦酯联合其他核苷（酸）类似物治疗慢性乙型肝炎患者肾功能的变化

目的 以往的研究表明替比夫定（LDT）和阿德福韦酯（ADV）单药治疗可以影响估算肾小球滤过率（eGFR）。本研究的目的是评估以ADV为基础的联合治疗对慢性乙型肝炎（CHB）患者肾功能的影响。方法 自2007年2月～2015年10月诊治的164例CHB患者,其中恩替卡韦（ETV）联合ADV治疗42例,拉米夫定（LAM）联合ADV组68例、替比夫定（LDT）联合ADV组54例。比较3组治疗104周时血清肌酐（sCr）、eGFR和eGFR≥90 ml·min^-1·1.73 m²患者构成比的变化,并分析影响患者基线eGFR受损的危险因素。结果 在治疗104周时,ETV联合ADV组血清sCr较基线升高（67 μmol/L 对 73 μmol/L,P=0.012）,LAM联合ADV组血清sCr较基线也升高（68 μmol/L 对 79 μmol/L,P=0.008）, 而LDT联合ADV组血清sCr水平较基线降低（69 μmol/L 对 64 μmol/L,P=0.023）;ETV联合ADV组eGFR较基线下降（107.8 ml·min^-1·1.73 m² 对96.1ml·min^-1·1.73 m²,P=0.004）,LAM联合ADV 104周eGFR较基线下降（105.4 ml·min^-1·1.73 m²对87.3 ml·min^-1·1.73 m²,P=0.000）, 而LDT联合ADV组eGFR较基线升高（104.1ml·min^-1·1.73 m²对116.2 ml·min^-1·1.73 m²,P=0.005）;LDT联合ADV组肾功能正常患者的比例明显高于ETV联合ADV组和LAM联合ADV组（P=0.002,P=0.001）;多因素分析显示,年龄（P=0.035）、男性（P=0.005）、基线eGFR（P<0.001）、LAM联合ADV（P<0.008）、ETV联合ADV（P=0.03）为预测基线eGFR下降>20%的独立危险因素。结论 LDT 联合ADV治疗对肾脏具有保护作用,能改善eGFR,逆转轻度肾功能不全。对肾脏有潜在损伤的患者,可通过应用或联用LDT进行补救治疗。     

Estimation of renal function by three CKD-EPI equations in Chinese HIV/AIDS patients: A STROBE-compliant article

Assessing renal function accurately is important for human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recommended three equations to calculate estimated glomerular filtration rate (eGFR). There is evidence that eGFR based on the combination of serum creatinine and cystatin C is the most accurate of the three equations. But there is limited data on the comparison of three CKD-EPI equations in Chinese HIV/AIDS patients. The aim of our study was to compare the three CKD-EPI equations in Chinese HIV/AIDS population and assess renal function.Cross-sectional, single center, prospective study.One hundred seventy two Chinese adult HIV/AIDS patients were enrolled, including 145 (84.3%) males and 27 (15.7%) females. Mean age was 40(±12) years old. Overall mean eGFR based on serum creatinine, cystatin C and the combination of the 2 markers was 112.6(±19.0) mL/min/1.73 m², 92.0(±24.2)mL/min/1.73 m², and 101.7(±21.8)mL/min/1.73 m², respectively (P = .000). The eGFR calculated by serum creatinine alone is higher than eGFR calculated by combination of serum creatinine and cystatin C, and eGFR calculated by cystatin C individual is lower than eGFR calculated by combination of the 2 markers.Of the 3 CKD-EPI equations, the CKD-EPI_scr-cys equation may have the most accuracy in evaluating renal function in Chinese HIV/AIDS patients while the CKD-EPI_scr equation may overestimate renal function and the CKD-EPI_cys equation may underestimate renal function.     

不同核苷（酸）类似物治疗慢性乙型肝炎患者对eGFR的影响

目的 本研究旨在研究在接受核苷（酸）类似物（NAs）治疗的慢性乙型肝炎（CHB）患者对估算的肾小球滤过率（eGFR）的影响。方法 40例替诺福韦（TDF）、56例替比夫定（LDT）和68例恩替卡韦（ETV）初治的CHB患者,采用慢性肾脏病流行病学合作研究公式 （CKD-EPI）方程对基线和治疗24个月 eGFR进行评估。结果 在治疗24个月时,ETV组和TDF组eGFR分别为（89.5±13.2） ml·min^-1·1.73 m^-2和（93.8±13.2） ml·min^-1·1.73 m^-2,均明显较基线下降【分别为（93.4±9.8） ml·min^-1·1.73 m^-2,P=0.041和（98.6±11.2） ml·min^-1·1.73 m^-2,P=0.016】,而LDT组eGFR为（108.5±10.9） ml·min^-1·1.73 m^-2,明显较基线升高【（96.6±10.3） ml·min^-1·1.73 m^-2,P=0.002】;基线时3组患者eGFR构成比无统计学差异（P=0.870）,而在治疗24个月时3组患者eGFR构成比有统计学差异（P=0.028）,LDT组肾功能正常者的比例明显高于ETV和TDF组（P=0.001）,TDF组和ETV组eGFR构成比无统计学差异（P=0.861）;24个月时,ETV和TDF组分别有16.7%（3/18）和44.4%（4/9）基线肾功能正常者进展成eGFR<90 ml·min^-1·1.73 m^-2,而69.2%（9/13）LDT组基线肾功能损伤患者eGFR水平恢复至正常（≥90 ml·min^-1·1.73 m^-2）。结论 应用LDT长期治疗CHB患者能改善eGFR水平,而应用TDF和ETV有可能导致eGFR降低。     

Telbivudine protects renal function in patients with chronic hepatitis B infection in conjunction with adefovir‐based combination therapy

Previous studies have demonstrated that the treatment of chronic hepatitis B (CHB) infection with adefovir (ADV) can impair renal function. In contrast, treatment with telbivudine (LdT) improves renal function in CHB patients. The aim of this study was to evaluate the renoprotective effect of LdT in CHB patients receiving ADV‐based combination therapy. The effects of treatment with ADV + LdT on renal function were compared to those resulting from treatment with ADV + entecavir (ETV), ADV + lamivudine (LAM), ADV alone and ETV alone. The consecutive cohort analysis included 831 CHB patients who received ADV + LdT, ADV + LAM, ADV + ETV, ADV alone or ETV alone for 96 weeks. Alterations in estimated glomerular filtration rate (eGFR) were compared between the five groups using a linear mixed‐effects model. HBV DNA levels were also compared between the five groups during the 96‐week period. Among the five treatment groups, significant improvements in eGFR were observed in the ADV + LdT and ADV + LAM groups over time (P < 0.001 for each group compared with baseline eGFR). In patients with a baseline eGFR between 50 and 90 mL/min, the change in eGFR was the most significant in the ADV + LdT group (+0.641 mL/min; P < 0.001). Age, gender, baseline eGFR and treatment option were significant predictive factors for eGFR changes. In conclusion, our results suggest that the combination therapy of LdT and ADV is significantly associated with renoprotective effects in CHB patients when compared with other ADV‐based combination or single therapies.     

肾小球滤过率评估方程在2型糖尿病患者中的应用

目的 观察慢性肾脏病流行合作组（CKD-EPI）方程、糖尿病膳食改良实验（简化MDRD）方程及苦味酸法校正至酶法（MDRD-IDMS）方程估算T2DM患者肾小球滤过率（GFR）的适用性. 方法 T2DM患者188例,用上述方程计算eGFR,与肾动态显像测得的GFR进行比较,分析eGFR在不同肾功能分期的适用性. 结果 CKD-EPI方程的偏差[-9.40 ml/（min·1.73 m2）]小于简化MDRD[-12.61 ml/（min·1.73 m2）]及MDRD-IDMS[-10.20 ml/（min·1.73m2）].其30％、50％符合率（53.7％、80.3％）高于简化MDRD（45.7％、71.3％）及MDRD-IDMS（50.7％、76.1％）（P＜0.01）.诊断肾功能不全受试者工作特征（ROC）曲线下面积以CKD-EPI方程最高（0.928）,效能最好.在不同肾功能分期中,CKD-EPI方程在糖尿病慢性肾脏疾病（CKD）1～2期有较低的偏差及更好的准确性,MDRD-IDMS与简化MDRD方程分别在CKD 3期、CKD 4～5期为优. 结论 3种方程均存在不同程度的偏差;相对而言,CKD-EPI方程可能更适合评估T2DM患者的eGFR.     

Comparison of the Effects of Telbivudine and Entecavir Treatment on Estimated Glomerular Filtration Rate in Patients with Chronic Hepatitis B

Background/Aims

The aim of this study was to evaluate the estimated glomerular filtration rate (eGFR) during telbivudine (LdT) versus entecavir (ETV) treatment in chronic hepatitis B (CHB) patients with underlying comorbidities such as diabetes mellitus (DM), hypertension, and cirrhosis.

Methods

From 2010 to 2012, 116 CHB patients treated with LdT and 578 treated with ETV were compared in this real-practice cohort. The mean changes in eGFR (Modification of Diet in Renal Disease [MDRD] formula) from baseline to months 6, 12, and 18 were analyzed using a linear mixed model.

Results

In LdT-treated patients, the mean eGFR increased by 7.6% at month 18 compared with the eGFR at baseline (MDRD formula in mL/min/1.73 m²). However, in ETV-treated patients, the mean eGFR decreased by 4.1% at month 18 compared with the eGFR at baseline. In the LdT-treated patients with DM, hypertension, cirrhosis or low eGFR <90 mL/min/1.73 m², the mean eGFR showed a steady improvement, whereas the mean eGFR was reduced in the same subgroups of ETV-treated patients.

Conclusions

The eGFR gradually increased over time during LdT treatment, especially in patients with mild abnormal eGFR at baseline, and in those with DM, hypertension, and cirrhosis, whereas a reduction in eGFR was seen with ETV treatment.     

高龄慢性肾脏病患者肾小球滤过率评估公式比较

目的 评价常用的肾小球滤过率评估公式在高龄慢性肾脏病CKD患者中的适用性.方法 选择高龄CKD患者217例,采用CG公式、校正CG公式、简化MDRD公式、改良简化MDRD公式（rMDRD公式）、针对中国CKD患者的改良简化MDRD公式（cMDRD公式）、CKD-EPI公式分别估测GFR,与BSA标准化的以Gates法^99mTc-DPTA法测定的GFR（mGFR）进行比较.采用偏差、准确率、MSPR、线性相关及直线回归分析、Bland-Altman曲线分析等方法评估各公式的优劣.并探索使用数据转换的方式进一步对估测公式的应用价值进行评估.结果 CKD-EPI公式较其他公式具有较小的偏差（估测偏差绝对值百分数=26.57 mL·min^-1·1.73 m^-2,P=0.048）、更优的准确性（15％准确率=31.8％,P＜0.001;30％准确率=56.68％,P=0.043）和更强的相关性（r=0.756,P＜0.001）,然而各公式30％准确率均低于60％,Bland-Altman曲线分析显示校正CG公式一致性较好（＜60 mL·min^-1· 1.73 m^-2）,其余公式一致性均欠佳.经数据转换,可改善各公式的准确性.结论 当血肌酐的测定方法为酶法时,以临床常用的GFR评估公式预测高龄CKD患者的GFR,可能产生明显偏差.从本研究提示,CKD-EPI公式表现优于其他公式,可能更适合我国高龄CKD患者.     

动脉粥样硬化性肾动脉狭窄患者肾动脉支架术后肾功能的长期变化及相关因素分析

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。