冠心病患者的肾动脉狭窄及介入治疗

目的　评价冠心病患者中肾动脉狭窄的相关因素及血管内支架术的临床价值。方法　包括 5 4例肾动脉狭窄患者和同期性别匹配的 5 7例肾动脉正常者 ,记录两组的临床特征、冠心病易患因素和血清肌酐浓度。以标准方法行冠脉和肾动脉造影及支架术。结果　肾动脉狭窄组平均年龄和血清肌酐显著增高 ,高血压和高脂血症显著增多 ,但两组的吸烟和糖尿病情况相似。肾动脉狭窄患者更易发生冠脉病变 (尤其是多支血管病变 )。 5 4例肾动脉狭窄 (单侧 5 0例 ,双侧 4例 )患者中 ,4 6例接受经皮肾动脉支架术治疗 ,各例手术成功。术后 2周 ,2 6例肾功能改善 ,2 4例高血压者血压控制良好。结论　冠心病合并肾动脉狭窄与年龄、高血压和高脂血症相关 ,血管内支架术对保护肾功能和控制高血压具重要临床作用。

Renal artery stenosis and stent treatment in patients with coronary artery disease

Objective To determine the factors related to renal artery stenosis (RAS) and value of renal stenting in patients with coronary artery disease (CAD).Methods Clinical features, coronary risk factors, serum creatinine level and status of CAD were compared between 54 patients with RAS and 57 sex matched controls. Results Patients in RAS group were older and had higher occurrence of renal dysfunction, hypertension, hyperlipidemia and coronary disease (especially multi vessel disease), but the status of cigarette smoking and diabetes was similar. Forty six patients with severe RAS (luminal narrowing >70%) underwent successful stent implantation. Two weeks after interventional treatment, renal function was improved in 26 patients and blood pressure was well controlled in 24.Conclusions Age, hypertension and hyperlipidemia are the factors influencing occurrence of RAS in patients with CAD. Stent implantation plays an important role in the protection of renal function and control of hypertension.