动脉粥样硬化性肾动脉狭窄与良性小动脉肾硬化临床特点的差异分析

目的 分析比较动脉粥样硬化性肾动脉狭窄(ARAS)与良性小动脉肾硬化(BN)患者的临床特征，以提高对这2种疾病的认识。方法 回顾性分析82例拟诊BN患者的肾血管彩色多普勒超声及肾动脉造影检查结果，统计ARAS的发生率。比较ARAS与BN患者的年龄、性别、家族史、血压、尿蛋白排泄、血清学等指标以及眼底、心脏结构、血管形态等临床参数的差异，探讨2种疾病与各临床参数的相关关系。 结果 82例拟诊BN患者中确诊缺血性肾病(IRD)17例(20.7%)，其中13例(15.9%)为ARAS。血管彩色多普勒超声诊断符合率为89.5%(17例/19例)。ARAS组与BN组在年龄、高血压家族史、高血压病程、冠心病史、体重指数、吸烟、总胆固醇、血糖、左心室重量指数、双肾长径等的差异有统计学意义。肾血管彩色多普勒超声显示ARAS组与BN组在肾动脉与主动脉峰值流速比、收缩期峰值速度、舒张末期速度、叶间动脉阻力指数等的差异有统计学意义。结论 临床拟诊的BN患者不能排除ARAS。部分BN与ARAS临床特征相似，病史、实验室检查等只能作为初步筛查手段。血管多普勒超声诊断在临床上实用性强。肥胖、吸烟、高血脂、高血糖是ARAS的危险因素。

Differential analysis of clinical features in atherosclerotic renal artery stenosis and benign nephrosclerosis

Objective To analyze and compare the clinical characteristics of atherosclerotic renal artery stenosis (ARAS) and benign nephrosclerosis (BN) in order to distinguish the ARAS from BN. Method A retrospective study was performed on 82 hypertensive patients with renal injury. Patients were divided into BN and ARAS group according to renal artery doppler scanning. The clinical date such as age, gender, family medical history, blood pressure, urine protein excretion, serum indexes, eyeground and blood vessel morphology were analyzed. Results Ischemic renal disease (IRD) was identified in 17/82 patients (20.7%), among whom 13 (13/82, 15.9%) exhibited ARAS. 17/19 (89.5%) patients were correctly identified by doppler ultrasound scanning. Between ARAS and BN, there were significant differences in age, family medical history, course of hypertension , body mass index, smoking, total cholesterol, serum glucose, left ventricle mass index, kidney size. Renal artery duplex scanning showed significant differences in renal-aortic ratio, peak systolic velocity, end-diastolic velocity, resistive index of arteries in ARAS versus BN. Conclusions BN diagnosed clinically can not exclude the possibility of ARAS, which may also exhibit an insidious nature . Color doppler ultrasonography is the best screening method with a predictive value. Obesity, smoking, hyperlipidemia and hyperglycemia are risk factors of ARAS.