肾动脉狭窄并冠状动脉多支病变患者部分或完全冠状动脉血运重建对比分析

目的 探讨在肾动脉狭窄合并冠状动脉粥样硬化性心脏病（冠心病）的患者中进行冠状动脉介入治疗时,选择部分或完全冠状动脉血运重建方法的临床效果差异.方法 收集2006年1月至2011年1月在广东省人民医院进行肾动脉及冠状动脉介入治疗的肾动脉狭窄合并冠心病患者共287例,其中177例进行了冠状动脉完全血运重建（complete revascularization,CR）,110例为部分冠状动脉血运重建（incomplete revascularization,ICR）.然后进行术后2年的随访调查,比较两种介入治疗策略的临床疗效以及其远期预后的差异.结果 两种治疗策略的整体住院病死率比较,差异无统计学意义（Х^2=0.474,P=0.491）.术后CR组的收缩压及舒张压较基线降低,差异有统计学意义（P均＜0.01）;而ICR组收缩压及舒张压与基线相比,差异无统计学意义（P＞0.05）.两组术前和术后肾功能、心功能改善的情况及住院时间比较,差异无统计学意义（P均＞0.05）.两组2年随访病死率及主要心血管事件发生率比较,差异无统计学意义（P均＞0.05）.结论 肾动脉狭窄患者在进行肾动脉及冠状动脉介入治疗时,进行冠状动脉完全血运重建和部分冠状动脉血运重建术效果相近,但完全血运重建有助于血压的控制.

Comparative analysis of complete coronary revascularization and incomplete coronary revascularization in patients with renal artery stenosis and multi-vessel coronary disease

Objectives To compare the clinical effects of complete revascularization （CR） and incomplete revascularization （ICR） with percutaneous coronary intervention （PCI） in patients with renal artery stenosis （RAS） and coronary artery disease （CAD）.Methods A total of 287 patients with RAS combined with CAD received percutaneous transluminal renal angioplasty with stent（PTRAS） and PCI from January 2006 to January 2011 in Guangdong General Hospital were enrolled in this research.Of them,177 patients were given PTRAS and CR,while the other 110 were given PTRAS and ICR.After operation,all these patients had been followed-up at least for 2 years to compare the differences in clinical effects and long-term prognosis between the two strategies.Results In-hospital mortality of the two strategies had no significant difference （Х^2=0.474,P=0.491）.Postoperative systolic pressure and diastolic pressure of CR group were significantly lower when compared with those before operation （P〈0.01）,while postoperative systolic pressure and diastolic pressure of ICR group had no significant difference compared with those before operation （P〉0.05）.There were no significant differences in inprovement of postoperative renal function,cardiac function and duration of hospitalization between the two strategies （P〉0.05）.During the followed-up for 2 years,there were no significant differences in mortality and incidence of major adverse cardiac events between the two groups （P〉0.05）.Conclusions For patients with RAS and CAD who need operations of PTRAS and PCI,CR strategy and ICR strategy have the similar effect,but CR strategy contributes more to the control of blood pressure.