冠心病患者肾动脉狭窄的发生率及相关因素

目的探讨冠状动脉造影中顺路肾动脉造影的意义,进一步明确动脉粥样硬化性肾动脉狭窄的相关危险因素。方法总结分析410例因拟诊冠心病而行冠状动脉造影并常规术中顺路行选择性双肾动脉造影患者的临床资料,分析冠心病患者中动脉粥样硬化性肾动脉狭窄的发生情况。以显著动脉粥样硬化性肾动脉狭窄为自变量,行Logistic多元回归分析,明确动脉粥样硬化性肾动脉狭窄的危险因素。结果410例患者共发现动脉粥样硬化性肾动脉狭窄88例(21.4%),其中轻度狭窄30例(7.3%),中度狭窄40例(9.7%),重度狭窄18例(4.3%)。冠状动脉病变阳性的285例中,动脉粥样硬化性肾动脉狭窄的患病率为26.3%(75/285),明显高于冠状动脉阴性患者[10.4%(13/125),P<0.05]。狭窄超过30%的肾动脉血管共130支,其中61.5%位于开口部位,36.9%位于主干,仅3.8%位于分支血管。多因素Logistic回归分析表明,动脉粥样硬化性肾动脉狭窄的独立危险因素为女性、高胆固醇、低高密度脂蛋白、血肌酐异常、左主干病变、冠状动脉三支病变。结论冠状动脉粥样硬化患者中动脉粥样硬化性肾动脉狭窄的发生率为26.3%,冠状动脉造影的同时行顺路肾动脉造影安全可行。但动脉粥样硬化性肾动脉狭窄与冠心病并不完全平行,女性、高胆固醇、低高密度脂蛋白、血肌酐异常、左主干病变及冠状动脉三支病变是动脉粥样硬化性肾动脉狭窄的独立危险因素。

The Prevalence and Related Factor of Atherosclerotic Renal Artery Stenosis in Patients with Coronary Heart Disease

Aim To evaluate the prevalence of atherosclerotic renal artery stenosis(ARAS) in patients undergoing selective coronary angiography,determine the relationship of ARAS and coronary heart disease(CHD),and to investigate the related factors of ARAS.Methods A total of 410 patients with suspected CHD underwent selective renal artery angiography immediately after coronary angiography.Independent sample test and multivariate logistic regression analysis were used to study the independent risk predictors of ARAS.Results 88(21.4%) patients observed with ARAS were included 7.3% in early,9.7% in mediate and 4.3% in severity.The incidence of ARAS in 285 patients with CHD was 26.3%,and it was higher than in patients without CHD(10.4%,P<0.05).130 renal arteries were narrow more than 30% of lumen diameter,with 61.5% in the ostial,36.9% in the main stem,and 3.8% in the branch of renal artery.The multivariate logistic regression analysis released that the important related factors were female,hypercholesterolemia,lower high density lipoprotein(HDL),early renal disfunction,3-vessel lesions and left main lesion in coronary arteries.Conclusions It is useful to perform selective renal artery angiography following coronary angiography.ARAS is not parallel with CHD.Female,hypercholesterolemia,low HDL,early renal disfunction,CHD with 3-vessel lesions and left main lesion are the independently predicts risks for ARAS.