缺血性卒中患者动脉粥样硬化性肾动脉狭窄的患病情况及危险因素分析

目的了解缺血性卒中患者动脉粥样硬化性肾动脉狭窄（ARAS）的患病情况及其危险因素。方法2008年1月至2013年3月，在我院因缺血性卒中行脑血管造影及肾动脉造影患者596例。任1支肾动脉狭窄≥50％诊断为ARAS。分析ARAS患病率，同时行多因素logistic回归分析，分析其危险因素。结果颅内动脉狭窄（ICAS）203例（34．1％），其中狭窄≥50％者108例（18．1％）；颅外动脉狭窄（ECAS）250例（41．9％），其中狭窄≥50％者149例（25．0％）；颅内、外动脉狭窄率比较差异有统计学意义（x^2=7．86，P〈0．05）。ARAS患者77例（12．9％），ECAS（350％）组中ARAS患病率（30．2％，45／149）高于ICAS（≥50％）组（18．5％，20／108），差异有统计学意义（X^2=4．52，P〈0．05）。单因素分析筛选后，logistic回归分析显示，年龄≥60岁（P〈0．05，OR=2．48）及ECAS（／〉50％）（P〈0．05，OR=5．37）是ARAS的独立危险因素。结论ARAS在缺血性脑卒中患者中相对较常见，年龄≥60岁及ECAS（≥50％）的缺血性脑卒中患者应行肾动脉评估，尽早发现ARAS。

Prevalence and risk factor of atherosclerotic renal artery stenosis in patients with ischemic stroke

Objective To investigate the prevalence and risk factors of atherosclerotic renal artery stenosis （ARAS） in patients with ischemic stroke （IS）. Methods A total of 596 consecutive patients with ischemic stroke underwent cerebrovascular and renal angiography at our hospital from January 2008 to March 2013. Renal artery stenosis was defined as at least one of renal artery narrowing ≥ 50% of luminal diameter. Multivariate logistic regression analysis was performed to investigate the association of the clinical variables with ARAS. Results Intracranial arterial stenosis （ICAS） was identified in 203 patients （34. 1%）, including 108 cases （18.5%） with arteriostenosis ≥ 50%. Extracranial arterial stenosis （ECAS） was identified in 250 patients （41.9%） , including 149 cases （25.0%） with arteriostenosis ≥50%. The prevalence of ECAS was higher than that of ICAS（ X^2 = 7. 86 ,P 〈0. 05 ）. ARAS was identified in 77 patients （12. 9% ） , and the prevalence of ARAS in patients with ECAS ≥50% was higher than that in with ICAS ≥50% （30. 2 % vs. 18. 5%, X^2 =4. 52,P〈0. 05）. Multivariate analysis showed that the age≥ 60 y （ OR ： 2.48, P 〈 0. 05 ） and ECAS ≥ 50% （ OR： 5.37, P 〈 0. 05 ） were independent risk factors for prevalence of ARAS. Conclusion ARAS is a relatively common finding among patients with ischemic stroke, suggesting that renal angiography should be performed in elderly IS patients, especially for those combined with severe ECAS.