CAJ | 학술논문

目的动脉粥样硬化性肾动脉狭窄（ARAS）与心血管疾病等密切相关，介入治疗能解除动脉狭窄，但其临床疗效却受到质疑，本实验通过严格把握介入治疗指征，分析ARAS患者单纯药物优化治疗与药物合并介入治疗的临床疗效。方法选择2010年1月至2011年1月确诊为ARAS ，其肾动脉狭窄程度大于或等于70％的患者，通过综合评价肾脏情况（肾脏大小、肾动脉狭窄程度、患侧肾小球滤过率、动脉狭窄处血流压力阶差等）、临床并发症等，选择药物优化治疗组（拒绝行介入治疗患者）或药物优化合并介入治疗组，记录患者治疗前后血压、血清肌酐、心功能、心血管事件、再入院次数等，随访1年，评价单纯药物优化治疗与介入合并药物治疗的临床疗效。结果<br>　　共入选120例患者，介入组48例，药物组72例，两组基础资料差异无统计学意义，介入组治疗前后血压下降明显，其中3例治愈，24例血压改善，21例无效，服用降压药物数量前后比较差异无统计学意义，平均肌酐轻度降低；药物组需要服用更多降压药物控制血压，平均肌酐轻度升高。在ARAS合并心衰患者分组中，介入合并药物治疗能改善心衰患者心功能，减少1年内因心衰、心绞痛、肺水肿及再住院次数。结论介入合并药物治疗能更好地改善ARAS患者心功能，两者对血清肌酐改善均无明显影响。
목적동맥죽양경화성신동맥협착（ARAS）여심혈관질병등밀절상관，개입치료능해제동맥협착，단기림상료효각수도질의，본실험통과엄격파악개입치료지정，분석ARAS환자단순약물우화치료여약물합병개입치료적림상료효。방법선택2010년1월지2011년1월학진위ARAS ，기신동맥협착정도대우혹등우70％적환자，통과종합평개신장정황（신장대소、신동맥협착정도、환측신소구려과솔、동맥협착처혈류압력계차등）、림상병발증등，선택약물우화치료조（거절행개입치료환자）혹약물우화합병개입치료조，기록환자치료전후혈압、혈청기항、심공능、심혈관사건、재입원차수등，수방1년，평개단순약물우화치료여개입합병약물치료적림상료효。결과<br>　　공입선120례환자，개입조48례，약물조72례，량조기출자료차이무통계학의의，개입조치료전후혈압하강명현，기중3례치유，24례혈압개선，21례무효，복용강압약물수량전후비교차이무통계학의의，평균기항경도강저；약물조수요복용경다강압약물공제혈압，평균기항경도승고。재ARAS합병심쇠환자분조중，개입합병약물치료능개선심쇠환자심공능，감소1년내인심쇠、심교통、폐수종급재주원차수。결론개입합병약물치료능경호지개선ARAS환자심공능，량자대혈청기항개선균무명현영향。
Objective Atherosclerotic renal artery stenosis (ARAS) is closely related to cardiovascular disea-ses .Interventional therapy can relieve artery stenosis ,but clinical effects have been challenged .Through strict control indications for interventional treatment ,this research aims to evaluate the clinical curative effects between ARAS pa-tients treated with drugs only and patients treated with drugs combined with intervention .Methods 120 patients who were diagnosed as ARAS and renal artery stenosis area ≥70% have been recruited during the period of January 2010 to January 2011 .Through comprehensive evaluations of kidney (renal size ,renal artery stenosis degree ,the ipsilateral glomerular filtration rate ,pressure gradients across renal artery stenosis ) and clinical complications ,patients have been divided into drug therapy group (patients refused interventional therapy ) and drug therapy combined with inter-ventional therapy group .Patients'blood pressure ,serum creatinine ,cardiac function ,cardiovascular events and read-mission times were recorded before and after treatment .The followed up was one year .Results In the 120 patients , 48 cases were in interventional group ,72 cases were in drug group .In interventional group ,the blood pressure im-proved significantly (P<0 .01) ,3 patient were cured ,24 patients blood pressure improved ,21 cases were invalid . There were no significant difference in the number of antihypertensive drug (P>0 .05) ,average serum creatinine re-duced mildly ;Drug group needed to take more drugs to control blood pressure ,and average serum creatinine elevated mildly .While in the group of ARAS patients combined with heart failure ,interventional therapy can improve heart function of patients with heart failure ,reduce the number of hospitalizations due to heart failure ,angina and pulmona-ry edema within 1 year .Conclusion Intervention combined with drug therapy and drug therapy alone can both effec-tively control blood pressure ,however the patients in intervention combined with drug therapy team after treatment take fewer antihypertensive drugs .Compared to drug therapy ,intervention combined with drug therapy can signifi-cantly improve patients'cardiac function ,reduce the readmission caused by heart failure ,angina and pulmonary edema of patients with ARAS and heart failure .However ,there was no significant effect on Serum creatinine between the two groups .