在进行冠状动脉造影的高血压患者中进行肾动脉造影筛查，并在特设经皮血运重建术后进行 6 个月随访。

Screening renal artery angiography in hypertensive patients undergoing coronary angiography and 6-month follow-up after ad hoc percutaneous revascularization.

机构信息

Swiss Cardiovascular Center Bern, University Hospital Bern, Bern, Switzerland.

出版信息

J Hypertens. 2010 Apr;28(4):842-7. doi: 10.1097/HJH.0b013e32833510e5.

DOI:10.1097/HJH.0b013e32833510e5

PMID:19952777

Abstract

OBJECTIVE

To determine the prevalence and independent predictors of significant atherosclerotic renal artery stenosis (RAS) in unselected hypertensive patients undergoing coronary angiography and to assess the 6-month outcome of those patients with a significant RAS.

METHODS

One thousand, four hundred and three consecutive hypertensive patients undergoing drive-by renal arteriography were analyzed retrospectively. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of RAS. In patients with significant RAS (>or=50% luminal narrowing), 6-month follow-up was assessed and outcome was compared between patients with or without renal revascularization.

RESULTS

The prevalence of significant RAS was 8%. After multivariate analysis, coronary [odds ratio 5.3; 95% confidence interval (CI) 2.7-10.3; P < 0.0001], peripheral (odds ratio 3.3; 95% CI 2.0-5.5; P < 0.0001), and cerebral artery (odds ratio 2.8; 95% CI 1.5-5.3; P = 0.001) diseases, and impaired renal function (odds ratio 2.9; 95% CI 1.8-4.5; P < 0.0001) were found as independent predictors. At least one of these predictors was present in 96% of patients with RAS. In 74 patients (66%) with significant RAS, an ad hoc revascularization was performed. At follow-up, creatinine clearance was significantly higher in revascularized than in nonrevascularized patients (69.2 vs. 55.5 ml/min per 1.73 m, P = 0.029). By contrast, blood pressure was comparable between both groups, but nonrevascularized patients were taking significantly more antihypertensive drugs as compared with baseline (2.7 vs. 2.1, follow-up vs. baseline; P = 0.0066).

CONCLUSION

The prevalence of atherosclerotic RAS in unselected hypertensive patients undergoing coronary angiography was low. Coronary, peripheral, and cerebral artery diseases, and impaired renal function were independent predictors of RAS. Ad hoc renal revascularization was associated with better renal function and fewer intake of antihypertensive drugs at follow-up.

摘要

目的

确定在接受冠状动脉造影的未选择的高血压患者中，严重动脉粥样硬化性肾动脉狭窄（RAS）的发生率和独立预测因子，并评估这些患者中严重 RAS 的 6 个月转归。

方法

回顾性分析了 1403 例连续接受驱动式肾动脉造影的高血压患者。进行单变量和多变量逻辑回归分析以确定 RAS 的独立预测因子。在有严重 RAS（≥50%管腔狭窄）的患者中，评估 6 个月的随访，并比较有或无肾血管重建的患者的结果。

结果

严重 RAS 的发生率为 8%。经多变量分析，冠状动脉疾病[比值比 5.3；95%置信区间（CI）2.7-10.3；P<0.0001]、外周动脉疾病[比值比 3.3；95%CI 2.0-5.5；P<0.0001]和脑动脉疾病[比值比 2.8；95%CI 1.5-5.3；P=0.001]，以及肾功能不全[比值比 2.9；95%CI 1.8-4.5；P<0.0001]是 RAS 的独立预测因子。有 RAS 的患者中，这些预测因子中的至少一种存在于 96%的患者中。在 74 例（66%）有严重 RAS 的患者中，进行了特定的血管重建术。在随访时，血管重建组的肌酐清除率明显高于未血管重建组（69.2 与 55.5 ml/min/1.73 m，P=0.029）。相比之下，两组的血压相当，但与基线相比，未血管重建组患者服用的降压药物明显更多（2.7 与 2.1，随访与基线；P=0.0066）。