Alhadad A, Mattiasson I, Ivancev K, Lindblad B, Gottsäter A
Vascular Centre, University of Lund, University Hospital, Malmö, Sweden.
Int Angiol. 2009 Apr;28(2):106-12.
This retrospective study evaluated long-term effects of percutaneous transluminal renal angioplasty (PTRA) in atherosclerotic renal artery stenosis (ARAS), and predictors of benefit on blood pressure (BP).
During 1997-2003, 234 patients (age 69+/-11 years, 138 [59%] males) underwent PTRA for ARAS at Malmö Vascular Centre. Cure was defined as diastolic (D)BP<90 mmHg and systolic (S)BP <140 mmHg off antihypertensive medication. Improvement was defined as DBP <90 mmHg and/or SBP <140 mmHg on the same or reduced number of medications, or reduction in DBP of >or=15 mmHg with the same or reduced number of medications. Benefit was defined as cure or improvement.
After PTRA, SBP and DBP decreased (P<0.001), and remained lower (P<0.001) until last follow-up after 4.1+/-3.3 years. Antihypertensive medication decreased (P<0.001), and remained lower at one month (P<0.001), one year (P<0.01), and last follow-up (P<0.05). Renal function was unchanged until last follow-up, when it deteriorated (P<0.001). Patients showing benefit of PTRA on BP at last follow-up (N.=150 [64%]) used more antihypertensive drugs before PTRA (P=0.012), especially angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs) (P=0.010), and diuretics (P=0.015). In logistic regression, use of ACEi or ARBs failed to reach significancy (P=0.054). Patients dying during follow up (N.=100 [43%]) showed higher age (P<0.0001) and s-creatinine (P<0.0001), lower glomerular filtration rate (P<0.0001), and higher frequency of diabetes mellitus (P<0.005). In logistic regression only age (P=0.009) and diabetes mellitus (P=0.014) predicted mortality.
We confirmed beneficial effects on BP with PTRA in ARAS. ACEi, ARB and diuretic treatment before PTRA predict favourable long-term BP-response in univariate analysis.
本回顾性研究评估了经皮腔内肾血管成形术（PTRA）治疗动脉粥样硬化性肾动脉狭窄（ARAS）的长期效果以及血压（BP）获益的预测因素。
1997年至2003年期间，234例患者（年龄69±11岁，138例[59%]为男性）在马尔默血管中心接受了针对ARAS的PTRA治疗。治愈定义为停用抗高血压药物后舒张压（D）BP<90 mmHg且收缩压（S）BP<140 mmHg。改善定义为使用相同数量或更少数量的药物时DBP<90 mmHg和/或SBP<140 mmHg，或使用相同数量或更少数量的药物时DBP降低≥15 mmHg。获益定义为治愈或改善。
PTRA术后，SBP和DBP下降（P<0.001），并在4.1±3.3年的末次随访前一直保持较低水平（P<0.001）。抗高血压药物用量减少（P<0.001），并在1个月（P<0.001）、1年（P<0.01）和末次随访时（P<0.05）一直保持较低水平。直到末次随访时肾功能保持不变，随后恶化（P<0.001）。在末次随访时显示PTRA对BP有获益的患者（n = 150例[64%]）在PTRA前使用了更多的抗高血压药物（P = 0.012），尤其是血管紧张素转换酶抑制剂（ACEi）或血管紧张素II受体阻滞剂（ARBs）（P = 0.010）以及利尿剂（P = 0.015）。在逻辑回归分析中，使用ACEi或ARBs未达到显著水平（P = 0.054）。随访期间死亡的患者（n = 100例[43%]）年龄更大（P<0.0001）、血清肌酐更高（P<0.0001）、肾小球滤过率更低（P<0.0001）且糖尿病发生率更高（P<0.005）。在逻辑回归分析中，只有年龄（P = 0.009）和糖尿病（P = 0.014）可预测死亡率。
我们证实了PTRA治疗ARAS对BP有有益效果。在单因素分析中，PTRA前使用ACEi、ARB和利尿剂治疗可预测长期良好的BP反应。
