Ziakka Stavroula, Ursu Michaela, Poulikakos Dimitris, Papadopoulos Christophoros, Karakasis Filippos, Kaperonis Nikolaos, Papagalanis Nicolas
Nephrology Department,Corgialenio-Benakio Hospital, Athens, Greece.
Ren Fail. 2008;30(10):965-70. doi: 10.1080/08860220802389334.
There is no consensus about the renal function outcome after revascularization with stenting in atherosclerotic renovascular disease. In the present study, the outcome in BP control and renal function in patients with renovascular disease treated with percutaneous angioplasty and stent placement is compared with the outcome in patients with renovascular disease treated with medical treatment only. Additionally, the impact of oxidative stress and eosinophil count in peripheral blood as predictors of renal function deterioration in renovascular disease irrespective of treatment is investigated.
Eighty-two patients with renovascular disease were enrolled into a follow-up study (47.5+/-35.4 months). Thirty-six patients (group 1) underwent revascularization and stenting, and 46 patients (group 2) were on medical treatment only. In all patients, serum creatinine concentration, eosinophil count (EO) in peripheral blood, and estimation of oxidative stress with dROMs test were determined before and at the end of the follow-up.
In revascularized patients (group 1), hypertension was cured in 11.1% and improved in 66.6%. Renal function improved in 30.5% and worsened in 36.2% of patients. In the medical treatment arm (group 2), hypertension improved in 71.4% of the patients. Renal function remained stable in 69.8% of patients and worsened in 30.2%. Cox regression analysis showed that higher levels of eosinophil count and higher levels of ROS, irrespectively of mode of treatment, were associated with renal function deterioration (i.e., serum creatinine increase more than 20% during follow-up).
Revascularization was not superior to medical treatment in renal survival but had a greater positive impact on blood pressure control. Eosinophil count and oxidative stress were the stronger predictive factors for serum creatinine increase.
对于动脉粥样硬化性肾血管疾病患者进行支架血管重建术后的肾功能转归，目前尚无共识。在本研究中，将接受经皮血管成形术和支架置入术治疗的肾血管疾病患者的血压控制和肾功能转归与仅接受药物治疗的肾血管疾病患者的转归进行比较。此外，还研究了无论治疗方式如何，氧化应激和外周血嗜酸性粒细胞计数作为肾血管疾病肾功能恶化预测指标的影响。
82例肾血管疾病患者纳入一项随访研究（随访时间47.5±35.4个月）。36例患者（第1组）接受血管重建和支架置入术，46例患者（第2组）仅接受药物治疗。所有患者在随访开始时和结束时均测定血清肌酐浓度、外周血嗜酸性粒细胞计数（EO）以及用dROMs试验评估氧化应激。
在接受血管重建的患者（第1组）中，11.1%的患者高血压治愈，66.6%的患者高血压改善。30.5%的患者肾功能改善，36.2%的患者肾功能恶化。在药物治疗组（第2组）中，71.4%的患者高血压得到改善。69.8%的患者肾功能保持稳定，30.2%的患者肾功能恶化。Cox回归分析表明，无论治疗方式如何，较高的嗜酸性粒细胞计数水平和较高的活性氧水平与肾功能恶化相关（即随访期间血清肌酐升高超过20%）。
血管重建术在肾脏存活方面并不优于药物治疗，但对血压控制有更大的积极影响。嗜酸性粒细胞计数和氧化应激是血清肌酐升高的更强预测因素。
