Przewlocki Tadeusz, Kablak-Ziembicka Anna, Tracz Wieslawa, Kopec Grzegorz, Rubis Pawel, Pasowicz Mieczyslaw, Musialek Piotr, Kostkiewicz Magdalena, Kozanecki Artur, Stompór Tomasz, Sulowicz Wladyslaw, Sokolowski Andrzej
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Pradnicka 80, 31-202 Krakow, Poland.
Nephrol Dial Transplant. 2008 Feb;23(2):580-5. doi: 10.1093/ndt/gfm622. Epub 2007 Oct 10.
Renal atherosclerosis is associated with increased cardiovascular mortality. This study aimed to determine the prevalence and predictors of renal artery stenosis (RAS) in patients with coronary artery disease (CAD) and supraaortic arteries (SA) stenosis.
Renal angiography was performed in 1193 (807 men) consecutive patients referred for coronary or SA angiography. Group I included 296 (136 men, 60.1 +/- 9.5 years) patients with no significant (< 50%) lesion in coronary arteries or SA; group II included 706 (526 men, 62.2 +/- 9.7 years) patients with stenosis > or = 50% within single arterial territory (coronary arteries or SA) and group III included 191 (145 men, 64.9 +/- 8.5 years) patients with stenosis > or = 50% in both territories.
Some RAS was found in 55 (18.6%) patients in group I, 250 (35.4%) patients in group II and 115 (60.2%) patients in group III (P < 0.001). The proportion of patients with RAS > or = 50% in groups I, II and III was 3.3, 6.2 and 18.3%, respectively (P < 0.001). RAS prevalence increased with the number of stenosed coronary arteries (38.4% in 1-vessel, 42.1% in 2-vessel, 48.5% in 3-vessel CAD, P < 0.001). Independent predictors of RAS > or = 50% identified by logistic regression analysis were SA stenosis [relative risk (RR) = 3.28, P < 0.001], 2-3-vessel-CAD (RR = 2.04, P = 0.002), creatinine level > or = 1.07 mg/dl (RR = 2.95, P < 0.001), hypertension (RR = 2.97, P = 0.012) and body mass index < 25 kg/m(2) (RR = 1.42, P = 0.169). A calculated score for RAS > or = 50% prediction (based on the regression model) was reliable (coefficient of determination, R = 0.978) and showed a sensitivity of 77.5% and a specificity of 63.9%.
RAS prevalence and severity increases with the number of arterial territories involved and CAD severity. The following independent predictors of RAS > or = 50% were identified: SA involvement, 2-3-vessel-CAD, serum creatinine level and hypertension.
肾动脉粥样硬化与心血管死亡率增加相关。本研究旨在确定冠心病（CAD）和主动脉弓上动脉（SA）狭窄患者肾动脉狭窄（RAS）的患病率及预测因素。
对1193例（807例男性）因冠状动脉或SA血管造影而连续就诊的患者进行了肾血管造影。第一组包括296例（136例男性，年龄60.1±9.5岁）冠状动脉或SA无明显（<50%）病变的患者；第二组包括706例（526例男性，年龄62.2±9.7岁）单动脉区域（冠状动脉或SA）狭窄≥50%的患者，第三组包括191例（145例男性，年龄64.9±8.5岁）两个区域狭窄≥50%的患者。
第一组55例（18.6%）患者发现有某种程度的RAS，第二组250例（35.4%）患者，第三组115例（60.2%）患者（P<0.001）。第一组、第二组和第三组中RAS≥50%的患者比例分别为3.3%﹑6.2%和18.3%（P<0.001）。RAS患病率随冠状动脉狭窄数量增加而升高（单支血管病变时为38.4%，双支血管病变时为42.1%，三支血管病变时为48.5%，P<0.001）。经逻辑回归分析确定的RAS≥50%的独立预测因素为SA狭窄[相对危险度（RR）=3.28，P<0.001]、双支至三支血管病变的CAD（RR=2.04，P=0.002）、肌酐水平≥1.07mg/dl（RR=2.95，P<0.001）、高血压（RR=2.97，P=0.012）和体重指数<25kg/m²（RR=1.42，P=0.169）。根据回归模型计算的RAS≥50%预测评分可靠（决定系数，R=0.978），敏感性为77.5%，特异性为63.9%。
RAS的患病率和严重程度随受累动脉区域数量及CAD严重程度增加而升高。确定了以下RAS≥50%的独立预测因素：SA受累、双支至三支血管病变的CAD、血清肌酐水平和高血压。
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