支架重建血运治疗老年粥样硬化性肾动脉狭窄的远期临床结果

目的 回顾性研究老年动脉粥样硬化性肾动脉狭窄(ARAS)患者行经皮腔内肾动脉支架置入重建血运术(PTRAS)的远期临床疗效.方法 选择2003年1月至2009年12月在中国人民解放军总医院老年肾科住院患者中,年龄≥65岁的高血压患者经肾动脉造影确诊为ARAS、肾动脉狭窄面积≥70%的病例,分析患者PTRAS术后长期的血压、肾功能的变化趋势及术后并发症.结果 共65例患者、73根肾动脉行PTRAS治疗,平均随访时间(31±11)个月.老年患者PTRAS术后3 d血压(mm Hg,1 mm Hg=0.133 kPa)即明显下降(术前154±24/79±11比术后132±14/ 69±8,P＜0.01),这种显著的降压作用可持续到术后36个月.PTRAS术后口服降压药物的种类(种)也略减少(2.3±1.1比2.1±1.0).老年ARAS患者PTRAS后对比剂肾病的发病率为9.2%,Logistic回归分析显示术前合并糖尿病(P=0.0072;OR=13.51)、肾小球滤过率<30 ml·min-1·1.73 m-2(P=0.0002;OR=519.27)及收缩压≥180 mm Hg(P= 0.0134 ;OR=13.16)均显著增加PTRAS后发生对比剂肾病的风险;而术后即刻水化治疗(P=0.0266;OR=0.10)可以显著降低术后对比剂肾病的发生.PTRAS术后12至36个月内,患者的肾功能9.1%～18.4%可改善,67.3%～55.3%保持不变,23.4%～26.3%出现恶化.Logistic回归分析显示,术前合并糖尿病的老年ARAS患者PTRAS术后12个月时发生肾功能恶化的风险显著增高(P=0.0277;OR=6.32).PTRAS术后再狭窄率为13.8%.结论 老年ARAS患者的高血压水平在PTRAS术后起至术后36个月内显著降低,易于控制在正常范围,但PTRAS改善老年ARAS患者肾功能的作用有限.

Abstract：

Objective To evaluate the long-term effects of percutaneous transluminal renal angioplasty with stent (PTRAS) on hypertension and renal function in elderly patients with atherosclerotic renal artery stenosis(ARAS). Methods The data of elderly ARAS patients as diagnosed by angiography(stenosis≥70%) were retrospectively collected. PTRAS was performed in 65 patients. The average follow-up period was 30.9 months. Results There were significant decrease in BP(blood pressure, mm Hg, 1 mm Hg=0.133 kPa) (before: 154±24/79±119 vs after: 132±14/69±8; P<0.01) at Day 3 post-PTRAS and the decrease of BP continued until 36 months after PTRAS. The average category of antihypertensive medication also decreased from 2.3±1.1 to 2.1±1.0. The incidence of contrast-induced nephropathy (CIN) was 9.2％. Logistic regression analysis showed that the factors of pre-operative diabetes mellitus, GFR≤30 ml·min-1·1.73 m-2, systolic pressure ≥180 mm Hg and hydration therapy had a significant relationship with the incidence of CIN (P=0.0072;OR=13.51; P=0.0002; OR=519.27; P=0.0134 ; OR=13.16 and P=0.0266; OR=0.10; respectively). Renal function improved in 9.1%-15.8% of patients, stabilized in 67.3%-55.3% and deteriorated in 23.4%-28.9% of patients at Months 12-36 post-PTRAS. Logistic regression analysis showed that the diabetics had a higher risk of deteriorating renal function at month 12 post-PTRAS（P=0.0277; OR=6.32）.The restenosis rate was 13.8%. Conclusion PTRAS is beneficial in the control of blood pressure in elderly ARAS patients within 36 months after operation. The post-PTRAS improvement of renal function in elderly patients is limited.

Long-term follow-up of elderly patients with atherosclerotic renal artery stenosis treated by percutaneous transluminal angioplasty with stent implantation

Objective To evaluate the long-term effects of percutaneous transluminal renal angioplasty with stent (PTRAS) on hypertension and renal function in elderly patients with atherosclerotic renal artery stenosis(ARAS). Methods The data of elderly ARAS patients as diagnosed by angiography(stenosis≥70%) were retrospectively collected. PTRAS was performed in 65 patients. The average follow-up period was 30.9 months. Results There were significant decrease in BP(blood pressure, mm Hg, 1 mm Hg=0.133 kPa) (before: 154±24/79±119 vs after: 132±14/69±8; P<0.01) at Day 3 post-PTRAS and the decrease of BP continued until 36 months after PTRAS. The average category of antihypertensive medication also decreased from 2.3±1.1 to 2.1±1.0. The incidence of contrast-induced nephropathy (CIN) was 9.2％. Logistic regression analysis showed that the factors of pre-operative diabetes mellitus, GFR≤30 ml·min-1·1.73 m-2, systolic pressure ≥180 mm Hg and hydration therapy had a significant relationship with the incidence of CIN (P=0.0072;OR=13.51; P=0.0002; OR=519.27; P=0.0134 ; OR=13.16 and P=0.0266; OR=0.10; respectively). Renal function improved in 9.1%-15.8% of patients, stabilized in 67.3%-55.3% and deteriorated in 23.4%-28.9% of patients at Months 12-36 post-PTRAS. Logistic regression analysis showed that the diabetics had a higher risk of deteriorating renal function at month 12 post-PTRAS（P=0.0277; OR=6.32）.The restenosis rate was 13.8%. Conclusion PTRAS is beneficial in the control of blood pressure in elderly ARAS patients within 36 months after operation. The post-PTRAS improvement of renal function in elderly patients is limited.