Methodist DeBakey Heart and Vascular Center, Department of Cardiovascular Surgery, The Methodist Hospital, Houston, TX 77030, USA.
J Vasc Surg. 2010 Apr;51(4):926-32. doi: 10.1016/j.jvs.2009.09.042.
Endovascular therapy for symptomatic atherosclerotic renal artery stenosis (ARAS) is common and effective in the well-selected patient. Hypertension is a common indication for intervention and a major component of metabolic syndrome (MetS). The impact of MetS on outcomes after percutaneous renal intervention is unknown.
We performed a retrospective analysis of records from patients who underwent endovascular intervention for ARAS and were followed by duplex ultrasound between January 1990 and January 2008. MetS was defined as the presence of >or=3 of the following criteria: Blood pressure >or=140 mm Hg/>or=90 mm Hg; triglycerides >or=150 mg/dL; high-density lipoprotein <or=50 mg/dL for women and <or=40 mg/dL for men; fasting blood glucose >or=110 mg/dL; or body mass index >or=30 kg/m(2). The average follow-up period was 3.3 years. Clinical benefit defined as freedom from renal-related morbidity (increase in persistent creatinine >20% of baseline, progression to hemodialysis, death from renal-related causes) or freedom from recurrent hypertension, anatomic patency, restenosis, and patient survival were measured.
Five hundred ninety-two renal artery interventions were performed in 427 patients. Fifty-two percent were identified as having MetS. Patients with MetS were more often female (35% vs 50%, NoMetS vs MetS). There were no significant differences in presenting symptoms. There was no peri-operative mortality and equivalent morbidity (6% vs 7%, NoMetS vs MetS). Patients with MetS had equivalent survival and cumulative patency. However, the MetS group had a lower five-year freedom from restenosis (87+/-2% vs 69+/-9%, NoMetS vs MetS; P < .01) and lower five-year retained clinical benefit (71+/-8% vs 45+/-8%, NoMetS vs MetS; P < .01) with a higher number progressing to hemodialysis (3% vs 13%, NoMetS vs MetS; P < .01). Individually, the components of MetS did not influence outcomes. Statin therapy did not influence outcomes.
MetS is associated with markedly reduced renal clinical benefit and increased progression to hemodialysis following endovascular intervention for atherosclerotic renal artery stenosis. MetS is thus a risk factor for poor long-term outcomes following renal interventions.
症状性动脉粥样硬化性肾动脉狭窄（ARAS）的血管内治疗在选择合适的患者中很常见且有效。高血压是介入治疗的常见指征，也是代谢综合征（MetS）的主要组成部分。MetS 对经皮肾介入治疗后的结果的影响尚不清楚。
我们对 1990 年 1 月至 2008 年 1 月期间接受 ARAS 血管内治疗并通过双功超声随访的患者的记录进行了回顾性分析。MetS 定义为存在以下 3 项或以上标准：血压≥140/90mmHg；甘油三酯≥150mg/dL；女性高密度脂蛋白＜50mg/dL，男性＜40mg/dL；空腹血糖≥110mg/dL；或体重指数≥30kg/m²。平均随访时间为 3.3 年。测量的临床获益定义为免于与肾脏相关的发病率（持续性肌酐升高＞基线的 20%、进展为血液透析、与肾脏相关的原因死亡）或免于复发性高血压、解剖通畅性、再狭窄和患者生存。
在 427 名患者中进行了 592 例肾动脉介入治疗。52%的患者被确定患有 MetS。患有 MetS 的患者中女性比例更高（35%比 50%，无 MetS 比 MetS）。两组的主要症状无明显差异。无围手术期死亡率和等效发病率（6%比 7%，无 MetS 比 MetS）。MetS 组患者的生存率和累积通畅率相当。然而，MetS 组五年内再狭窄的无复发率较低（87±2%比 69±9%，无 MetS 比 MetS；P<.01），五年内保留的临床获益较低（71±8%比 45±8%，无 MetS 比 MetS；P<.01），进展为血液透析的患者较多（3%比 13%，无 MetS 比 MetS；P<.01）。单独来看，MetS 的各个组成部分并未影响结果。他汀类药物治疗并未影响结果。
MetS 与血管内治疗动脉粥样硬化性肾动脉狭窄后明显降低的肾脏临床获益和进展为血液透析有关。因此，MetS 是肾介入治疗后长期预后不良的危险因素。
