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目的评价介入方法治疗老年动脉粥样硬化性肾动脉狭窄的疗效及临床相关因素。方法分析2001年1月至2004年12月广东省人民医院经肾动脉造影确诊肾动脉粥样硬化性肾动脉狭窄并经介入治疗的79例老年患者的治疗效果与临床因素的相关性。结果介入治疗后血压获益(治愈及改善)者占69.6%(55/79),无效者占30.4%(24/79);肾功能改善与稳定者占35.4%(28/79),无效者占64.6%(51/79)。单因素相关分析发现,介入治疗后血压的获益与术前蛋白尿及肾小球滤过率、术前收缩压及舒张压、术前肾动脉阻力指数有关;肾功能的获益与肾动脉狭窄的比例、术前用药的数量、术前24h蛋白尿显著相关。Logistic多因素逐步回归分析发现,肾动脉狭窄的程度是影响介入治疗高血压疗效的独立因素;而年龄、血肌酐是影响肾功能疗效的独立因素。结论肾动脉狭窄程度≥85%、年龄<75岁、治疗前血肌酐>133μmol/L的老年人动脉粥样硬化性肾动脉狭窄介入治疗效果较好。
Objective To evaluate the efficacy and clinical factors of interventional therapy in the treatment of senile atherosclerotic renal artery stenosis. Methods From January 2001 to December 2004, Guangdong Provincial People’s Hospital of Renal atherosclerotic renal artery stenosis confirmed by renal artery angiography and interventional treatment of 79 elderly patients with the treatment effect and clinical factors. Results The benefits of blood pressure (cure and improvement) were 69.6% (55/79) after interventional therapy, 30.4% (24/79) were ineffective, 35.4% (28/79) were improvement and stabilization of renal function, Accounting for 64.6% (51/79). Univariate correlation analysis showed that the benefit of blood pressure after interventional therapy was related to preoperative proteinuria and glomerular filtration rate, preoperative systolic blood pressure and diastolic blood pressure, preoperative renal artery resistance index; benefit of renal function and renal artery The narrow ratio, the number of preoperative medication, preoperative 24h proteinuria were significantly correlated. Logistic regression analysis showed that the degree of renal artery stenosis was an independent factor affecting the efficacy of interventional therapy for hypertension. However, age and serum creatinine were independent factors affecting renal function. Conclusions Interventional treatment of atherosclerotic renal artery stenosis in the elderly with good renal artery stenosis of ≥85%, age <75 years and serum creatinine> 133μmol / L before treatment.