摘要
目的观察经皮肾动脉支架置入术(PTRAS)治疗动脉粥样硬化性肾动脉狭窄(ARAS)的长期临床效果。方法选取北部战区总医院自2016年5月至2016年9月收治的行肾动脉造影明确诊断ARAS的197例患者为研究对象。根据治疗方式不同,将患者分入优化药物组(n=78)和药物联合PTRAS组(n=119)。比较两组患者的临床资料,术前术后的血压水平,术后的肾功能指标,以及终点事件发生率。采用Logistic回归分析两组患者全因死亡的危险因素。结果药物联合PTRAS组年龄、肾小球滤过率、低密度脂蛋白及既往冠心病史比例均低于优化药物组,入院收缩压、入院舒张压及既往高血压史、单侧肾动脉狭窄比例均高于优化药物组,差异有统计学意义(P<0.05)。两组术后第3天和术后6、12、36、60个月的收缩压均低于术前,差异有统计学意义(P<0.05);两组术后第3天和术后6、12、36、60个月的收缩压比较,差异无统计学意义(P>0.05)。与优化药物组比较,药物联合PTRAS组舒张压在术后6、12、60个月时降低明显,差异有统计学意义(P<0.05);两组术后不同观察时间收缩压改善程度差异无统计学意义(P>0.05)。两组术后第3天、12个月、36个月的肾小球滤过率、肾小球滤过率与基线的差值比较,差异均无统计学意义(P>0.05)。两组终点事件发生率比较,差异均无统计学意义(P>0.05)。术前肾小球滤过率<60 ml/(min·1.73 m^(2))、低密度脂蛋白水平升高、双侧肾动脉狭窄、肾动脉最重狭窄程度增加是优化药物组全因死亡的危险因素(P<0.05)。糖尿病史、左室射血分数降低、双侧肾动脉狭窄、肌酸激酶同工酶水平升高是药物联合PTRAS组全因死亡的危险因素(P<0.05)。结论优化药物治疗和药物联合PTRAS治疗均可有效改善ARAS患者血压;与优化药物治疗比较,联合PTRAS不能明显改善肾功能及减少终点事件发生;肾动脉狭窄程度较重为ARAS患者全因死亡的�
Objective To observe the long-term efficacy of percutaneous renal artery stenting(PTRAS)in the treatment of patients with atherosclerotic renal artery stenosis(ARAS).Methods A total of 197 patients with ARAS diagnosed by renal arteriography in General Hospital of Northern Theater Command from May 2016 to September 2016 were selected as the research objects.According to different treatment methods,patients were divided into optimal drug group(n=78)and drug combined with PTRAS group(n=119).The clinical data,preoperative and postoperative blood pressure levels,postoperative renal function indicators,and the incidence of end-point events were compared between the two groups.Logistic regression was used to analyze the risk factors of all-cause mortality in the two groups.Results The age,glomerular filtration rate,low density lipoprotein and the proportion of previous coronary heart disease history in the drug combined with PTRAS group were lower than those in the optimal drug group,and the systolic blood pressure on admission,diastolic blood pressure on admission,history of hypertension and the proportion of unilateral renal artery stenosis were higher than those in the optimal drug group,and the differences were statistically significant(P<0.05).The systolic blood pressure of the two groups at 3 days and 6,12,36,60 months after operation were lower than those before operation,and the differences were statistically significant(P<0.05).There was no significant difference in systolic blood pressure and diastolic blood pressure between the two groups at 3 days and 6,12,36 and 60 months after operation(P>0.05).Compared with the optimal drug group,the diastolic blood pressure in the drug combined with PTRAS group decreased significantly at 6,12 and 60 months after operation,and the difference was statistically significant(P<0.05).There was no significant difference in the improvement degree of systolic blood pressure between the two groups at different observation time after operation(P>0.05).There was no significant diffe
作者
周海鹏
张志强
王亚松
周铁楠
王效增
ZHOU Hai-peng;ZHANG Zhi-qiang;WANG Ya-song;ZHOU Tie-nan;WANG Xiao-zeng(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《临床军医杂志》
CAS
2022年第11期1116-1120,共5页
Clinical Journal of Medical Officers
基金
辽宁省“兴辽英才计划”资助项目(XLYC2008004)
