CAJ | 학술논문

目的观察同期行冠状动脉和肾动脉支架术对冠心病合并肾动脉狭窄患者心肾功能的影响,并分析影响患者长期预后的因素.方法入选2006年1月至2010年1月确诊的冠心病合并肾动脉狭窄患者169例,其中同期行冠状动脉和肾动脉支架术(联合组)149例,单纯行冠状动脉支架术(PCI组)20例.术后至少随访2年,记录基线及随访血压、血肌酐水平、超声心动图检查结果以及不良心肾脑血管事件.结果 PCI组左右肾动脉狭窄率均低于联合组(P均＜0.01).术后2年,联合组收缩压低于基线(P＜0.01),舒张压与基线比较差异无统计学意义(P ＞0.05);PCI组收缩压及舒张压均低于基线(P均＜ 0.01);超声心动图显示,2组患者的左心室心肌重量指数均低于基线(P均＜0.01),联合组较PCI组下降幅度更大(-55.6 g/m2比-12.8 g,/m2,P＜0.01);联合组估算肾小球滤过率(eGFR)小于基线[(41.7±18.9) ml·min-1·1.73 m-2比(44.7±17.4) ml·min-1·1.73 m-2,P＜0.01];PCI组手术前后eGFR差异无统计学意义(P＞0.05).对联合组患者的多因素Cox回归分析显示,基线肾功能不全不是不良心肾脑血管事件的危险因素(HR=0.986,P＞0.05).结论同期行冠状动脉和肾动脉支架术治疗冠心病合并肾动脉狭窄患者安全、有效,虽不能逆转肾功能下降,但有助于控制血压和减轻左心室肥厚.
목적 관찰동기행관상동맥화신동맥지가술대관심병합병신동맥협착환자심신공능적영향,병분석영향환자장기예후적인소.방법 입선2006년1월지2010년1월학진적관심병합병신동맥협착환자169례,기중동기행관상동맥화신동맥지가술(연합조)149례,단순행관상동맥지가술(PCI조)20례.술후지소수방2년,기록기선급수방혈압、혈기항수평、초성심동도검사결과이급불양심신뇌혈관사건.결과 PCI조좌우신동맥협착솔균저우연합조(P균＜0.01).술후2년,연합조수축압저우기선(P＜0.01),서장압여기선비교차이무통계학의의(P ＞0.05);PCI조수축압급서장압균저우기선(P균＜ 0.01);초성심동도현시,2조환자적좌심실심기중량지수균저우기선(P균＜0.01),연합조교PCI조하강폭도경대(-55.6 g/m2비-12.8 g,/m2,P＜0.01);연합조고산신소구려과솔(eGFR)소우기선[(41.7±18.9) ml·min-1·1.73 m-2비(44.7±17.4) ml·min-1·1.73 m-2,P＜0.01];PCI조수술전후eGFR차이무통계학의의(P＞0.05).대연합조환자적다인소Cox회귀분석현시,기선신공능불전불시불양심신뇌혈관사건적위험인소(HR=0.986,P＞0.05).결론 동기행관상동맥화신동맥지가술치료관심병합병신동맥협착환자안전、유효,수불능역전신공능하강,단유조우공제혈압화감경좌심실비후.
Objective To investigate the impact of simultaneous percutaneous transluminal renal artery stenting (PTRAS) and percutaneous coronary artery interventions (PCI) on cardiac and renal function in patients with renal artery stenosis (RAS) and coronary artery disease (CAD),and explore the factors affecting the long-term prognosis.Methods This retrospective cohort study enrolled 169 patients with RAS and CAD from January 2006 to January 2010,149 patients were intervened with PTRAS and PCI simultaneously (combined group) and the remaining 20 patients were treated with PCI (PCI group).All patients were followed up for at least 2 years.Clinical data including blood pressure,estimated glomerular filtration rate (eGFR),echocardiography and major adverse events were obtained.Results The average stenotic ratio of the left and right renal artery in PCI group were significantly lower than those in combined group (both P ＜ 0.01).After 2 years,there was a significant decrease in systolic blood pressure compared to baseline level in the combined group (P ＜ 0.01).In the PCI group,both systolic blood pressure and diastolic blood pressure were significantly lower during follow-up than at the baseline level(both P ＜ 0.01).Echocardiography examination showed that left ventricular mass index (LVMI) during follow up was significantly lower than the baseline value in both groups,and the reduction extent in the combined group was larger than in PCI group(-55.6 g/m2 vs.-12.8 g/m2,P ＜ 0.01).In the combined group,the eGFR value decreased from (44.7 ± 17.4) ml · min-1 · 1.73 m-2 to (41.7 ± 18.9) ml · min-1 · 1.73 m-2 (P ＜ 0.01).eGFR level remained unchanged in PCI group(P ＞ 0.05).Multivariate Cox regression analysis demonstrated that baseline renal dysfunction was not significantly related to the long-term adverse prognosis in combined group (HR =0.986,P ＞ 0.05).Conclusions Simultaneous PTRAS and PCI are safe and effective for treating patients with RAS and CAD.Simultaneous PTRAS and PCI are beneficial on controlling blood pressure and reducing left ventricular mass index but has no impact on renal function change.