动脉粥样硬化性肾动脉狭窄的发病趋势

目的 了解当前动脉粥样硬化性肾动脉狭窄（ARAS）的发病情况、临床特点和治疗现状。方法 分析北京大学第一医院1979年至2003年间经肾动脉造影证实为肾动脉狭窄的144例患者中87例ARAS患者的患病情况、临床特点、治疗方式和预后,并与其他原因引起的肾动脉狭窄的患者进行比较研究。结果 ALIAS占肾动脉狭窄病因的60．4％,分别占1979-1990和1991-2003年间肾动脉狭窄病因构成比的28．9％及71．7％。高血压见于93．1％的ARAS患者,37．9％出现近期高血压进展。狭窄度50％-74％的ARAS患者发生肾功能不全的比例为11．2％,狭窄度≥75％的ARAS患者发生肾功能不全的比例为35．8％,均高于相同狭窄度其他病因的肾动脉狭窄患者（均P〈0．05）。60．9％的ARAS患者采用单纯药物治疗,18．8％的患者采用介入治疗。ARAS患者的高血压控制率和肾功能有效率分别从1990年前54．5％和63．6％提高到1990年后的83．9％和85．5％。同时期内相同狭窄程度、相同血肌酐水平采用药物及介入治疗的患者相比,高血压控制有效率与肾功能有效率差异无统计学意义。结论 ALIAS已成为当前肾动脉狭窄的首要病因。联合应用多种降压药物或介入治疗对控制高血压和肾功能有相似的疗效。

The changing etiology and therapeutic situation of atherosclerotic renal artery stenosis

OBJECTIVE: To determine whether the etiology of renal artery stenosis changed. To investigate the clinical characteristics and current therapeutic situation of atherosclerotic renal artery stenosis (ARAS). METHODS: Retrospective analysis was performed in 144 cases of renal artery stenosis diagnosed by angiography (> or = 50% luminal narrowing) from 1979 to 2003. Eighty-seven of them were diagnosed as ARAS by special characteristics of angiography and clinical features. The clinical data of ARAS was compared with RAS caused by other diseases. RESULTS: The proportion of ARAS in all RAS was 60.4%. The proportion of ARAS was 28.9% during the period of 1980 to 1990 and 71.7% from the year of 1991 to 2003, respectively. The prevalence of hypertension was 90.8% among ARAS patients. Newly-progressive hypertension was more common among ARAS patients compared with RAS patients with other causes (37.9% vs 21.0%, P = 0.044). Renal dysfunction were more commonly seen among ARAS than non-ARAS patients in those with the same degree of stenosis (11.2% vs 6.9% for stenosis 50%-74%, P = 0.038; 35.8% vs 15.4% for stenosis > or = 75%, P = 0.046). Among ARAS cases, 60.9% were managed with antihypertensive agents only, 18.8% were managed by angioplasty with or without stents. After 1990, the improvement rate of blood pressure rose significantly but not for renal function. The improvement rate of blood pressure by angioplasty was similar with that by medication (84.1% vs 92.6% for stenosis 50%-74%, P = 0.39; 76.6% vs 80.1% for stenosis > or = 75%, P = 0.61). And the improvement or stable rate of renal function was not different (85.4% vs 85.7% for stenosis 50%-74%, P = 0.91; 77.8% vs 76.9% for stenosis > or = 75%, P = 0.83). CONCLUSION: ARAS is the predominant cause of RAS nowadays in stead of Takayasu arteritis. Medication is the mostly used management for ARAS, though more angioplasty with or without stents appear. The effect of medication for ARAS has improved since 1990. Most cases of ARAS could achieve ideal blood pressure control and similar renal function protection with either rational medication or angioplasty.