冠状动脉造影患者中肾动脉狭窄的发生率

目的　在进行冠状动脉 (冠脉 )造影的人群中观察肾动脉狭窄 (RAS)的发生率 ,并识别RAS的危险因素。方法　冠脉造影和心室造影结束后 ,进行非选择性肾动脉造影。临床因素和RAS的关系采用单变量和多变量Logistic回归分析。结果　 8个月内共入选 370例患者 ,平均年龄 6 0 6岁(2 9～ 81岁 ) ,其中 10 6例患者 (2 8 6 %)存在RAS ,6 3例患者 (17 0 %)存在显著的RAS(腔径狭窄≥5 0 %) ,43例患者 (11 6 %)存在轻度的RAS(直径狭窄 <5 0 %)。 41例患者 (11 1%)存在显著单侧RAS ,2 2例患者 (5 9%)存在显著双侧RAS。经单变量和多变量Logistic回归分析 ,独立预测因子为年龄(OR =1 0 6 ,95 %CI:1 0 3～ 1 10 ,P <0 0 0 0 1)、冠脉病变的严重程度 (OR =1 6 5 ,95 %CI:1 34～ 2 0 3,P <0 0 0 0 1)和外周血管疾病 (OR =2 6 4,95 %CI:1 2 7～ 5 4 7,P =0 0 0 95 )。结论　接受冠脉造影检查的患者中 ,RAS发病率高 ,多见于存在全身弥漫性动脉粥样硬化的老年患者。

High incidence of renal artery stenosis in patients undergoing coronary angiography

OBJECTIVE: It is important to identify patients at risk for atherosclerotic renal artery stenosis because renal artery stenosis is a progressive disease and a potentially correctable problem. This study is to evaluate the prevalence of angiographically-determined renal artery stenosis in a patient population undergoing routine coronary angiography, and to identify the risk factors for renal artery stenosis. METHODS: Before the procedure, demographic data, medical history, physical findings and laboratory data were obtained. After coronary angiography, abdominal aortography was performed to screen for the presence of renal artery stenosis over a 8-month period. In 370 patients (237 males, 133 females), mean age was 60.6 (29 to 81) years. And an univariate and multivariate Logistic regression analysis was made to explore the association of the clinical variables with renal stenosis. RESULTS: Renal artery narrowing was identified in 106 (28.6%) patients. Significant renal artery stenosis, defined as a narrowing of the diameter by more than 50%, was found in 63 patients (17.0%) and insignificant (< 50% diameter narrowing) stenosis was found in 43 patients (11.6%). Significant unilateral stenosis was present in 41 (11.1%) patients and bilateral stenosis was present in 22 (5.9%) patients. By univariate and multivariate logistic regression analysis, the association of clinical variables with renal artery stenosis was assessed. Multivariable predictors included age (OR = 1.06, 95% CI: 1.03 approximately 1.10, P < 0.0001), severity of coronary artery disease (OR = 1.65, 95% CI: 1.34 approximately 2.03, P < 0.0001) and peripheral vascular disease (OR = 2.64, 95% CI: 1.27 approximately 5.47, P = 0.0095). The variables such as sex, body mass index, hypertension, smoking history, hyperlipidemia, myocardial infarction, congestive heart failure, renal insufficiency and diabetes mellitus were not associated. CONCLUSION: Renal artery stenosis is a frequent finding in patients undergoing coronary angiography, especially in older people with generalized atherosclerosis.