Krijnen P, van Jaarsveld B C, Steyerberg E W, Man in 't Veld A J, Schalekamp M A, Habbema J D
Center for Clinical Decision Sciences and University Hospital Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
Ann Intern Med. 1998 Nov 1;129(9):705-11. doi: 10.7326/0003-4819-129-9-199811010-00005.
Renal artery stenosis is a rare cause of hypertension. The gold standard for diagnosing renal artery stenosis, renal angiography, is invasive and costly.
To develop a prediction rule for renal artery stenosis from clinical characteristics that can be used to select patients for renal angiography.
Logistic regression analysis of data from a prospective cohort of patients suspected of having renal artery stenosis. A prediction rule was derived from the regression model for use in clinical practice.
26 hypertension clinics in The Netherlands.
477 hypertensive patients who underwent renal angiography because they had drug-resistant hypertension or an increase in serum creatinine concentration during therapy with angiotensin-converting enzyme inhibitors.
Age, sex, atherosclerotic vascular disease, recent onset of hypertension, smoking history, body mass index, presence of an abdominal bruit, serum creatinine concentration, and serum cholesterol level were selected as predictors. The regression model was reliable (goodness-of-fit test, P > 0.2) and discriminated well between patients with stenosis and those with essential hypertension (area under the receiver-operating characteristic curve, 0.84). The diagnostic accuracy of the regression model was similar to that of renal scintigraphy, which had a sensitivity of 72% and a specificity of 90%.
In the diagnostic workup of patients suspected of having renal artery stenosis, the clinical prediction rule can be considered as an alternative to renal scintigraphy. It can help to select patients for renal angiography in an efficient manner by reducing the number of angiographic procedures without the risk for missing many renal artery stenoses.
肾动脉狭窄是高血压的一种罕见病因。诊断肾动脉狭窄的金标准——肾血管造影，具有侵入性且成本高昂。
根据临床特征制定肾动脉狭窄的预测规则，以用于选择进行肾血管造影的患者。
对疑似肾动脉狭窄的前瞻性队列患者的数据进行逻辑回归分析。从回归模型中得出一个预测规则用于临床实践。
荷兰的26家高血压诊所。
477例高血压患者，因耐药性高血压或在使用血管紧张素转换酶抑制剂治疗期间血清肌酐浓度升高而接受肾血管造影。
选择年龄、性别、动脉粥样硬化性血管疾病、高血压近期发病、吸烟史、体重指数、腹部杂音的存在、血清肌酐浓度和血清胆固醇水平作为预测因素。回归模型可靠（拟合优度检验，P>0.2），并且在狭窄患者和原发性高血压患者之间有良好的区分能力（受试者操作特征曲线下面积，0.84）。回归模型的诊断准确性与肾闪烁显像相似，肾闪烁显像的敏感性为72%，特异性为90%。
在疑似肾动脉狭窄患者的诊断检查中，临床预测规则可被视为肾闪烁显像的替代方法。它可以通过减少血管造影检查的数量，以有效的方式帮助选择进行肾血管造影的患者，而不会有遗漏许多肾动脉狭窄的风险。
