Zhao Jia-hui, Cheng Qing-li, Zhang Xiao-ying
Department of Geriatric Nephrology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2011 Jun 28;91(24):1673-6.
To evaluate the long-term effects of percutaneous transluminal renal angioplasty with stent (PTRAS) on hypertension and renal function in elderly patients with atherosclerotic renal artery stenosis (ARAS).
The data of elderly ARAS patients as diagnosed by angiography (stenosis ≥ 70%) were retrospectively collected. PTRAS was performed in 65 patients. The average follow-up period was 30.9 months.
There were significant decrease in BP (blood pressure, mm Hg, 1 mm Hg = 0.133 kPa) (before: 154 ± 24/ 79 ± 119 vs after: 132 ± 14/69 ± 8; P < 0.01) at Day 3 post-PTRAS and the decrease of BP continued until 36 months after PTRAS. The average category of antihypertensive medication also decreased from 2.3 ± 1.1 to 2.1 ± 1.0. The incidence of contrast-induced nephropathy (CIN) was 9.2%. Logistic regression analysis showed that the factors of pre-operative diabetes mellitus, GFR ≤ 30 ml×min(-1)·1.73 m(-2), systolic pressure ≥ 180 mm Hg and hydration therapy had a significant relationship with the incidence of CIN (P = 0.0072; OR = 13.51; P = 0.0002; OR = 519.27; P = 0.0134; OR = 13.16 and P = 0.0266; OR = 0.10; respectively). Renal function improved in 9.1%-15.8% of patients, stabilized in 67.3% - 55.3% and deteriorated in 23.4% - 28.9% of patients at Months 12 - 36 post-PTRAS. Logistic regression analysis showed that the diabetics had a higher risk of deteriorating renal function at month 12 post-PTRAS (P = 0.0277; OR = 6.32). The restenosis rate was 13.8%.
PTRAS is beneficial in the control of blood pressure in elderly ARAS patients within 36 months after operation. The post-PTRAS improvement of renal function in elderly patients is limited.
评估经皮腔内肾动脉支架成形术（PTRAS）对老年动脉粥样硬化性肾动脉狭窄（ARAS）患者高血压和肾功能的长期影响。
回顾性收集经血管造影诊断（狭窄≥70%）的老年ARAS患者的数据。65例患者接受了PTRAS治疗。平均随访期为30.9个月。
PTRAS术后第3天血压（血压，mmHg，1 mmHg = 0.133 kPa）显著下降（术前：154±24/79±119 vs术后：132±14/69±8；P < 0.01），且血压下降持续至PTRAS术后36个月。抗高血压药物的平均种类也从2.3±1.1降至2.1±1.0。对比剂肾病（CIN）的发生率为9.2%。Logistic回归分析显示，术前糖尿病、肾小球滤过率（GFR）≤30 ml×min⁻¹·1.73 m⁻²、收缩压≥180 mmHg和水化治疗等因素与CIN的发生率有显著关系（P = 0.0072；OR = 13.51；P = 0.0002；OR = 519.27；P = 0.0134；OR = 13.16；P = 0.0266；OR = 0.10；分别）。PTRAS术后12 - 36个月，9.1% - 15.8%的患者肾功能改善，67.3% - 55.3%的患者肾功能稳定，23.4% - 28.9%的患者肾功能恶化。Logistic回归分析显示糖尿病患者在PTRAS术后12个月肾功能恶化的风险更高（P = 0.0277；OR = 6.32）。再狭窄率为13.8%。
PTRAS对老年ARAS患者术后36个月内控制血压有益。老年患者PTRAS术后肾功能的改善有限。
