Valentine R J, Clagett G P, Miller G L, Myers S I, Martin J D, Chervu A
Department of Surgery, Dallas Veterans Administration Medical Center, TX.
J Vasc Surg. 1993 Sep;18(3):433-9; discussion 439-40.
This study was designed to determine the prevalence of unsuspected renal artery stenoses (RAS) in patients undergoing arteriography for evaluation of aneurysmal or occlusive vascular disease and whether symptomatic coronary artery disease (CAD) is more prevalent among patients with unsuspected RAS.
We reviewed the arteriograms and medical records of 346 consecutive patients with aortic aneurysms or occlusive disease in whom RAS was unsuspected on clinical grounds.
Aortography revealed unsuspected RAS (50% or greater diameter loss) in 98 patients (28%). Patients with RAS had a higher prevalence of mild, controlled hypertension (p < 0.001) and mild renal insufficiency (p < 0.001), but in no case was arteriography obtained to diagnose renovascular hypertension or ischemic nephropathy. Fifty-seven patients (58%) with unsuspected RAS had clinically overt CAD (documented myocardial infarction, positive coronary catheterization, previous coronary revascularization, ischemic electrocardiography changes, or angina pectoris), compared with 96 patients (39%) without RAS (p = 0.002). The correlation between the prevalence of CAD and RAS severity was highly significant (p < 0.001), and the relative odds ratio of CAD was highest for RAS measuring 75% or greater. Stepwise logistic regression analysis demonstrated three variables to be significantly and independently associated with CAD: 75% or greater RAS (p = 0.001), aortic aneurysm disease (p = 0.01), and hypertension (p = 0.001). RAS measuring 75% or greater diameter loss was associated with the highest estimated odds ratio: patients with this degree of RAS had a fourfold increase in the prevalence of clinically overt CAD. We also evaluated the relationship between RAS, mesenteric artery stenosis, and CAD; although RAS was more frequent among patients with mesenteric artery stenoses, mesenteric artery stenoses were not associated with CAD.
Unsuspected RAS is common among patients with peripheral vascular disease and should be considered an independent marker for CAD.
本研究旨在确定因动脉瘤或闭塞性血管疾病接受血管造影的患者中未被怀疑的肾动脉狭窄（RAS）的患病率，以及有症状的冠状动脉疾病（CAD）在未被怀疑有RAS的患者中是否更普遍。
我们回顾了346例连续性主动脉瘤或闭塞性疾病患者的血管造影图像和病历，这些患者临床上未被怀疑有RAS。
主动脉造影显示98例患者（28%）存在未被怀疑的RAS（直径损失50%或更大）。有RAS的患者轻度、可控性高血压（p<0.001）和轻度肾功能不全（p<0.001）的患病率较高，但均未因诊断肾血管性高血压或缺血性肾病而进行血管造影。57例（58%）未被怀疑有RAS的患者有临床明显的CAD（记录的心肌梗死、冠状动脉导管检查阳性、既往冠状动脉血运重建、缺血性心电图改变或心绞痛），而无RAS的96例患者（39%）有临床明显的CAD（p = 0.002）。CAD患病率与RAS严重程度之间的相关性非常显著（p<0.001），对于直径损失75%或更大的RAS，CAD的相对比值比最高。逐步逻辑回归分析显示，有三个变量与CAD显著且独立相关：直径损失75%或更大的RAS（p = 0.001）、主动脉瘤疾病（p = 0.01）和高血压（p = 0.001）。直径损失75%或更大的RAS与最高的估计比值比相关：有这种程度RAS的患者临床明显CAD的患病率增加了四倍。我们还评估了RAS、肠系膜动脉狭窄和CAD之间的关系；尽管肠系膜动脉狭窄患者中RAS更常见，但肠系膜动脉狭窄与CAD无关。
未被怀疑的RAS在周围血管疾病患者中很常见，应被视为CAD的独立标志物。
