Deitch J S, Hansen K J, Craven T E, Flack J M, Appel R G, Dean R H
Department of General Surgery, Wake Forest University Medical Center, Winston-Salem, North Carolina 27157-1095, USA.
J Vasc Surg. 1997 Sep;26(3):465-72; discussion 473. doi: 10.1016/s0741-5214(97)70039-9.
This retrospective review examines the results of atherosclerotic renal artery (RA) repair in consecutive hypertensive African-Americans treated at our center and compares these results with Caucasians treated during the same period.
From Jan. 1987 through Sep. 1996, a total of 485 patients underwent operative RA repair. Of these, 28 African-Americans and 370 Caucasians were managed for atherosclerotic renovascular disease. These cohorts were compared on the basis of preoperative blood pressure and renal function, extent of renal disease, extrarenal atherosclerosis, response to operation, and estimated survival.
The African-American cohort included nine men and 19 women (mean age, 62 years) with hypertension (mean blood pressure, 204 +/- 31/109 +/- 20 mm Hg) for an average of 10.2 +/- 7.5 years. Ischemic nephropathy (serum creatinine level, > 1.3 mg/dl) was present in 82% (n = 23) of the African-American group. RA reconstructions were unilateral in nine patients and bilateral in 19 patients (including repair to two solitary kidneys), for a total of 45 RA reconstructions (30 RA bypass procedures; eight transrenal/transaortic RA endarterectomy procedures; two RA reimplantations; five nephrectomies). Nine patients underwent combined aortic procedures (four abdominal aortic aneurysm; five occlusive disease). There was one perioperative death in the African-American group as a result of sepsis and multiple organ failure. Among surgical survivors, 20 African-American patients (74%) had a beneficial hypertension response (7% cured, 67% improved). Mean estimated glomerular filtration rate improved significantly from 34 to 42 ml/min/1.73 m2 (p < 0.001). In the 23 patients with ischemic nephropathy, 13 (57%) demonstrated greater than 20% decrease in serum creatinine level. In comparison with the 370 Caucasians (191 men, 179 women), the African-American cohort had significantly more preoperative heart disease (congestive heart failure or left ventricular hypertrophy; 68% vs 46%; p = 0.03) and tended toward more severe renal dysfunction (mean serum creatinine level, 2.5 vs 2.1 mg/dl; p = 0.25). However, African-Americans demonstrated a beneficial blood pressure and renal function response after operation, similar to Caucasians.
Our results indicate that the majority of selected African-Americans have a favorable blood pressure and renal function response to operative renal artery repair. This beneficial clinical response appears equivalent to the response observed in Caucasian patients and supports the search for RA disease in hypertensive African-Americans.
本回顾性研究分析了在我们中心接受治疗的连续性高血压非裔美国人的动脉粥样硬化性肾动脉（RA）修复结果，并将这些结果与同期治疗的白种人进行比较。
从1987年1月至1996年9月，共有485例患者接受了RA修复手术。其中，28例非裔美国人和370例白种人因动脉粥样硬化性肾血管疾病接受治疗。根据术前血压和肾功能、肾脏疾病程度、肾外动脉粥样硬化、手术反应及估计生存率对这些队列进行比较。
非裔美国人队列包括9名男性和19名女性（平均年龄62岁），高血压（平均血压204±31/109±20 mmHg）平均病程10.2±7.5年。82%（n = 23）的非裔美国人组存在缺血性肾病（血清肌酐水平>1.3 mg/dl）。RA重建术在9例患者中为单侧，19例患者为双侧（包括修复两个孤立肾），共进行了45次RA重建（30次RA搭桥手术；8次经肾/经主动脉RA内膜切除术；2次RA再植术；5次肾切除术）。9例患者接受了联合主动脉手术（4例腹主动脉瘤；5例闭塞性疾病）。非裔美国人组有1例围手术期死亡，死于败血症和多器官功能衰竭。在手术存活者中，20例非裔美国患者（74%）有有益的高血压反应（7%治愈，67%改善）。平均估计肾小球滤过率从34显著提高到42 ml/min/1.73 m2（p < 0.001）。在23例缺血性肾病患者中，13例（57%）血清肌酐水平下降超过20%。与370例白种人（191例男性，179例女性）相比，非裔美国人队列术前心脏病（充血性心力衰竭或左心室肥厚）显著更多（68%对46%；p = 0.03），且肾功能障碍倾向更严重（平均血清肌酐水平，2.5对2.1 mg/dl；p = 0.25）。然而，非裔美国人术后血压和肾功能反应良好，与白种人相似。
我们的结果表明，大多数选定的非裔美国人对手术性肾动脉修复有良好的血压和肾功能反应。这种有益的临床反应似乎与白种人患者观察到的反应相当，支持在高血压非裔美国人中寻找RA疾病。
