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目的了解当前动脉粥样硬化性肾动脉狭窄(ARAS)的发病情况、临床特点和治疗现状。方法分析北京大学第一医院1979年至2003年间经肾动脉造影证实为肾动脉狭窄的144例患者中87例ARAS患者的患病情况、临床特点、治疗方式和预后,并与其他原因引起的肾动脉狭窄的患者进行比较研究。结果ARAS占肾动脉狭窄病因的60.4%,分别占1979—1990和1991—2003年间肾动脉狭窄病因构成比的28.9%及71.7%。高血压见于93.1%的ARAS患者,37.9%出现近期高血压进展。狭窄度50%～74%的ARAS患者发生肾功能不全的比例为11.2%,狭窄度≥75%的ARAS患者发生肾功能不全的比例为35.8%,均高于相同狭窄度其他病因的肾动脉狭窄患者(均P<0.05)。60.9%的ARAS患者采用单纯药物治疗,18.8%的患者采用介入治疗。ARAS患者的高血压控制率和肾功能有效率分别从1990年前54.5%和63.6%提高到1990年后的83.9%和85.5%。同时期内相同狭窄程度、相同血肌酐水平采用药物及介入治疗的患者相比,高血压控制有效率与肾功能有效率差异无统计学意义。结论ARAS已成为当前肾动脉狭窄的首要病因。联合应用多种降压药物或介入治疗对控制高血压和肾功能有相似的疗效。
Objective To investigate the incidence, clinical characteristics and treatment status of atherosclerotic renal artery stenosis (ARAS). Methods The prevalence, clinical features, treatment and prognosis of 87 ARAS patients from 144 patients with renal artery stenosis who were confirmed by renal artery angiography during the period from 1979 to 2003 at Peking University First Hospital were analyzed and compared with those of other causes Arteriosclerosis in patients with comparative study. Results ARAS accounted for 60.4% of the causes of renal artery stenosis, accounting for 28.9% and 71.7% of the causes of renal artery stenosis between 1979-1990 and 1991-2003, respectively. Hypertension was found in 93.1% of patients with ARAS, and 37.9% showed recent hypertension. Renal insufficiency was 11.2% in ARAS patients with 50% to 74% stenosis and 35.8% in ARAS patients with stenosis≥75%, which were both higher than those in other etiologies of the same stenosis Patients (all P <0.05). 60.9% of ARAS patients treated with simple drugs, 18.8% of patients treated with intervention. The rates of hypertension control and renal function in patients with ARAS increased from 54.5% and 63.6% before 1990 to 83.9% and 85.5% after 1990, respectively. During the same period, the same degree of stenosis, the same serum creatinine levels using drugs and interventional treatment compared to the effective rate of hypertension control and renal function difference was not statistically significant. Conclusion ARAS has become the leading cause of renal artery stenosis. Combined use of a variety of antihypertensive drugs or interventional therapy for the control of hypertension and renal function have a similar effect.