CAJ | 학술논문

目的：探讨糖尿病合并肾动脉狭窄相关危险因素与高效临床检测方法，以期能及时发现糖尿病合并肾动脉狭窄患者，极早治疗，避免肾功能恶化。方法对120例糖尿病合并肾功能不全，或者难治性高血压的患者，应用肾动脉 CTA检查，根据有无肾动脉狭窄分为2组，收集各组患者年龄、血压、糖尿病病程、吸烟及冠心病病史等情况，彩超检查两肾长径差值、叶间动脉 RI 、肾动脉血流流速及颈动脉内膜厚度，实验室检查血肌酐、尿蛋白、血脂、胱抑素 C、糖化血红蛋白及同型半胱氨酸等指标。结果 DSA证实肾动脉CTA阳性患者均有不同程度肾动脉狭窄，肾动脉狭窄患者的年龄、血压、叶间动脉 RI 、肾动脉血流流速及颈动脉内膜厚度、血脂、胱抑素 C、糖化血红蛋白及同型半胱氨酸等指标均与非狭窄组有明显统计学差异，其中胱抑素C、糖化血红蛋白及同型半胱氨酸呈正相关。而2组患者两肾长径差值、血肌酐、尿蛋白无统计学差异。结论肾动脉 CTA检查发现肾动脉狭窄的准确率高达100%。糖尿病患者的年龄、高血压水平，糖尿病病程、高血脂、肾动脉血流流速、叶间动脉 RI 、颈动脉内膜厚度联合血清胱抑素C、糖化血红蛋白及同型半胱氨酸等指标可以及早发现肾动脉狭窄，可作为预测糖尿病动脉狭窄的指标应用于临床。
목적：탐토당뇨병합병신동맥협착상관위험인소여고효림상검측방법，이기능급시발현당뇨병합병신동맥협착환자，겁조치료，피면신공능악화。방법대120례당뇨병합병신공능불전，혹자난치성고혈압적환자，응용신동맥 CTA검사，근거유무신동맥협착분위2조，수집각조환자년령、혈압、당뇨병병정、흡연급관심병병사등정황，채초검사량신장경차치、협간동맥 RI 、신동맥혈류류속급경동맥내막후도，실험실검사혈기항、뇨단백、혈지、광억소 C、당화혈홍단백급동형반광안산등지표。결과 DSA증실신동맥CTA양성환자균유불동정도신동맥협착，신동맥협착환자적년령、혈압、협간동맥 RI 、신동맥혈류류속급경동맥내막후도、혈지、광억소 C、당화혈홍단백급동형반광안산등지표균여비협착조유명현통계학차이，기중광억소C、당화혈홍단백급동형반광안산정정상관。이2조환자량신장경차치、혈기항、뇨단백무통계학차이。결론신동맥 CTA검사발현신동맥협착적준학솔고체100%。당뇨병환자적년령、고혈압수평，당뇨병병정、고혈지、신동맥혈류류속、협간동맥 RI 、경동맥내막후도연합혈청광억소C、당화혈홍단백급동형반광안산등지표가이급조발현신동맥협착，가작위예측당뇨병동맥협착적지표응용우림상。
Objective To explore the risk factors of diabetes complicated with renal artery ste-nosis and effective clinical detection method,and discover the diabetic patients with renal artery steno-sis treated as soon as possible to avoid the deterioration of renal function.Methods 1 20 cases of diabe-tes complicated with renal insufficiency,or refractory hypertension were divided into two groups ac-cording to the results of DSA.The age,blood pressure,diabetes duration,history of smoking and coronary heart disease,etc were recorded.The length difference of two kidneys,interlobar artery re-sistance index,renal artery blood flow velocity and carotid intima-media thickness were detected by color Doppler ultrasound.Serum creatinine,urine protein,blood lipids,Cystatin C,HbA1 c and ho-mocystein were determined.Results DSA confirmed that all renal artery CTA positive patients had different degrees of renal artery stenosis.Ages,blood pressure,interlobar artery resistance index,re-nal artery blood flow velocity,carotid intima-media thickness,blood lipids,Cystatin C,HbA1 c and homocystein were of great significance between two groups.Cystatin C,HbA1 c and homocystein were positively correlated,but the length difference of two kidneys,serum creatinine and urine protein had no statistically significant difference between two groups.Conclusions The accuracy rate of renal ar-tery CTA detecting renal artery stenosis was 1 00%.The age of the patients with diabetes,blood pres-sure level,diabetes duration,hyperlipidemia,interlobar artery resistance index,renal artery blood flow velocity,carotid intima-media thickness,Cystatin C,HbA1 c and homocystein were helpful to find renal artery stenosis earlier.The indicators can be used in clinical practice to predict renal artery stenosis.