Kawarada Osami, Yokoi Yoshiaki, Morioka Nobuyuki, Takemoto Kazushi
Department of Cardiology, Kishiwada Tokushukai Hospital, Japan.
Circ J. 2007 Dec;71(12):1942-7. doi: 10.1253/circj.71.1942.
The prevalence and indicative clinical factors of renal artery stenosis (RAS) in the Japanese population are unclear.
The aim of this study was to investigate the prevalence of RAS in a selectively referred Japanese population and to determine any clinical factors related to RAS by initially screening with renal duplex ultrasonography. The 750 patients presenting because of possible or known cardio-and cerebrovascular diseases were prospectively studied. Duplex examination was performed in 729 patients (97.2%): 21 patients (2.8%) did not undergo it, because of technical impossibility. Duplex RAS was found in 38 patients (5.2%). Subsequently, a confirmatory renal angiography was obtained in 40 patients, investigating those who had duplex RAS or no duplex examination. Angiographic RAS was found in 35 patients (4.8%). The respective prevalences of duplex and angiographic RAS were 6.3% and 6.7% in coronary artery disease, 8.8% and 9.3% in multivessel coronary artery disease, 7.5% and 8.2% in heart failure, 5.1% and 4.3% in unstable angina pectoris, 20.0% and 22.2% in carotid artery stenosis, 10.3% and 10.2% in stroke, 20.0% and 20.0% in peripheral artery disease, and 12.0% and 11.8% in abdominal aortic aneurysm. Univariate analysis showed that patients with duplex RAS were older and had more atherosclerotic risk factors. Furthermore, they were more likely to be smokers and have hypertension, renal impairment, renal atrophy, left ventricular hypertrophy and cardio- and cerebrovascular diseases. Multivariate stepwise analysis showed that smoking, peripheral artery disease, abdominal aortic aneurysm and renal atrophy were independent predictors of duplex RAS.
RAS is frequent in Japanese patients with cardio- and cerebrovascular diseases. Initial screening for RAS by duplex ultrasonography is recommended for patients with complications, especially peripheral artery disease, abdominal aortic aneurysm and renal atrophy.
日本人群中肾动脉狭窄（RAS）的患病率及指示性临床因素尚不清楚。
本研究旨在调查选择性转诊的日本人群中RAS的患病率，并通过肾双功超声初步筛查确定与RAS相关的临床因素。对750例因可能或已知的心脑血管疾病就诊的患者进行前瞻性研究。729例患者（97.2%）接受了双功检查：21例患者（2.8%）因技术原因未进行检查。38例患者（5.2%）发现双功RAS。随后，对40例患者进行了确诊性肾血管造影，这些患者包括有双功RAS或未进行双功检查的患者。35例患者（4.8%）发现血管造影RAS。在冠心病患者中，双功和血管造影RAS的患病率分别为6.3%和6.7%；在多支冠状动脉疾病患者中分别为8.8%和9.3%；在心力衰竭患者中分别为7.5%和8.2%；在不稳定型心绞痛患者中分别为5.1%和4.3%；在颈动脉狭窄患者中分别为20.0%和22.2%；在中风患者中分别为10.3%和10.2%；在周围动脉疾病患者中分别为20.0%和20.0%；在腹主动脉瘤患者中分别为12.0%和11.8%。单因素分析显示，双功RAS患者年龄更大，有更多的动脉粥样硬化危险因素。此外，他们更有可能是吸烟者，患有高血压、肾功能损害、肾萎缩、左心室肥厚以及心脑血管疾病。多因素逐步分析显示，吸烟、周围动脉疾病、腹主动脉瘤和肾萎缩是双功RAS的独立预测因素。
RAS在患有心脑血管疾病的日本患者中很常见。对于有并发症的患者，尤其是周围动脉疾病、腹主动脉瘤和肾萎缩患者，建议通过双功超声对RAS进行初步筛查。
