切换至 "中华医学电子期刊资源库"
高级检索
中华老年病研究电子杂志

中华老年病研究电子杂志 ›› 2020, Vol. 07 ›› Issue (02) : 36 -39. doi: 10.3877/cma.j.issn.2095-8757.2020.02.009

所属专题： 文献；

临床研究

老年患者动脉粥样硬化性肾动脉狭窄的危险因素分析
陈强1, 左丙杰2, 刘岩1, 苏雷1, 孙国华1,†()   
  1. 1. 271400　泰安市宁阳县第一人民医院泌尿外科
    2. 271024　泰安市宁阳县满庄镇卫生院心血管内科
  • 收稿日期:2019-10-17 出版日期:2020-05-28
  • 通信作者: 孙国华
  • 基金资助:
    泰安市科技发展计划项目(2018NS0234)

Analysis of risk factors for arteriosclerosis renal artery stenosis

Qiang Chen1, Bingjie Zuo2, Yan Liu1, Lei Su1, Guohua Sun1,†()   

  1. 1. Department of Urology, First People's Hospital of Ningyang County, Taian 271400, China
    2. Department of Cardiovascular Medicine, Manzhuang Town Health Center, Taian 271024, China
  • Received:2019-10-17 Published:2020-05-28
  • Corresponding author: Guohua Sun
  • About author:
    Corresponding author: Sun Guohua, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

陈强, 左丙杰, 刘岩, 苏雷, 孙国华. 老年患者动脉粥样硬化性肾动脉狭窄的危险因素分析[J]. 中华老年病研究电子杂志, 2020, 07(02): 36-39.

Qiang Chen, Bingjie Zuo, Yan Liu, Lei Su, Guohua Sun. Analysis of risk factors for arteriosclerosis renal artery stenosis[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2020, 07(02): 36-39.

目的

探讨老年动脉粥样硬化性肾动脉狭窄（arteriosclerosis renal artery stenosis, ARAS）的危险因素。

方法

选取2016年1月至2019年6月在宁阳县第一人民医院接受肾动脉彩超检查的老年患者140例。比较ARAS患者与非ARAS患者的临床资料，将单因素分析（t检验或χ2检验）差异有统计学意义的指标纳入Logistic回归模型进行多因素分析。

结果

140例老年患者中ARAS 68例（ARAS组），无ARAS 72例（非ARAS组）。ARAS组患者高血压病史和糖尿病病史所占比例、年龄以及同型半胱氨酸、超敏C反应蛋白水平明显高于非ARAS组患者，差异有统计学意义（χ2=3.657、3.897，t=-2.970、3.989、-3.360；P<0.05）。Logistic回归分析显示，年龄、高血压病史及HCY、hs-CRP水平是老年ARAS的独立危险因素[OR（95%CI）=1.077（1.019-1.138）、4.814（2.006-11.552）、1.072（1.026-1.119）、1.345（1.190-1.520），P<0.01]。

结论

及早发现高危患者，并针对性改善危险因素，对于ARAS的治疗和预后有着重要的临床意义。

关键词: 动脉粥样硬化, 肾动脉狭窄, 危险因素, 超声检查
Objective

To investigate the risk factors of arteriosclerosis renal artery stenosis (ARAS) in aged patients.

Methods

140 elderly patients underwent renal artery color doppler ultrasound examination at First People's Hospital of Ningyang County from January 2016 to June 2019 were selected. The clinical data of ARAS patients and non-ARAS patients were compared. The indicators with statistically significant difference in univariate analysis (T test or chi-square test) were incorporated into Logistic regression model for multivariate analysis.

Results

Among the 140 patients, 68 patients were ARAS (ARAS group) and 72 patiens were non-ARAS (non-ARAS group). The age, the proportion of hypertension history and diabetes history, the levels of homocysteine (HCY) and hypersensitive C-reactive protein (hs-CRP) in the ARAS group were significantly higher than those in the non-ARAS Group (χ2=3.657, 3.897; t=-2.970, 3.989, -3.360; P < 0.05). Logistic regression analysis showed that age, hypertension history, HCY level and hs-CRP level were the independent risk factors [OR(95%CI)=1.077(1.019-1.138), 4.814(2.006-11.552), 1.072(1.026-1.119), 1.345(1.190-1.520), P < 0.01] in elderly patients with ARAS.

Conclusion

Early detection of high risk patients and targeted improvement of risk factors have important clinical significance for the treatment and prognosis of ARAS.

Key words: Arteriosclerosis, Renal artery stenosis, Risk factors, Ultrasound
表1 ARAS与非ARAS患者临床资料的比较
组别 例数 年龄（岁） 性别（男/女，例） 病史[例(%)] 吸烟[例（%）] 饮酒[例（%）]
糖尿病 高血压 冠心病
ARAS组 68 78.0±5.4 38/30 38（55.9） 40（58.8） 36（52.9） 32（47.1） 27（39.7）
非ARAS组 72 68.7±5.6 37/35 32（44.4） 35（48.6） 34（47.2） 28（38.9） 28（38.9）
检验值 ? t=-2.970 χ2=0.924 χ2=3.657 χ2=3.897 χ2=0.485 χ2=0.241 χ2=0.113
P值 ? <0.01 >0.05 <0.05 <0.05 >0.05 >0.05 >0.05
组别 例数 LDL-C（mmol/L） HDL-C（mmol/L） HCY（mol/L） hs-CRP（mg/L） SBP（mmHg） DBP（mmHg）
ARAS组 68 3.15±1.23 1.33±0.20 18.25±3.49 4.35±1.32 142.0±9.4 86.0±5.1
非ARAS组 72 3.16±1.21 1.32±0.30 13.87±2.68 2.29±1.56 129.0±8.5 78.0±6.3
检验值 ? t=-0.354 t=-0.311 t=3.989 t=-3.360 t=0.217 t=0.289
P值 ? >0.05 >0.05 <0.01 <0.01 >0.05 >0.05
表2 老年患者ARAS的多因素Logistic回归分析
指标 B Wald OR 95%CI P值
年龄 0.074 6.969 1.077 1.019-1.138 <0.01
糖尿病病史 0.592 0.975 1.807 0.558-5.847 >0.05
高血压病史 1.571 12.379 4.814 2.006-11.552 <0.01
HCY 0.069 9.661 1.072 1.026-1.119 <0.01
hs-CRP 0.296 22.592 1.345 1.190-1.520 <0.01
[1]
Derkx FH, Schalekamp MA. Renal artery stenosis and hypertension[J]. Lancet, 1994, 344(8917):237-239.
[2]
Rimmer JM, Gennari FJ. Atherosclerotic renovascular disease and progressive renal failure[J]. Annal Int Med, 1993, 118(9):712.
[3]
Zierler RE, Bergelin RO, Isaacson JA, et al. Natural history of atherosclerotic renal artery stenosis: A prospective study with duplex ultrasonography[J]. J Vasc Surg, 1994, 19(2):250-258.
[4]
Crowley JJ, Santos RM, Peter RH, et al. Progression of renal artery stenosis in patients undergoing cardiac catheterization[J]. Am Heart J, 1998, 136(5):913-918.
[5]
Cheung CM, Hegarty J, Kalra PA. Dilemmas in the management of renal artery stenosis[J]. Br Med Bull, 2005, 73-74:35-55.
[6]
Hansen KJ, Edwards MS, Craven TE, et al. Prevalence of renovascular disease in the elderly: A population-based study[J]. J Vasc Surg, 2002, 36(3):443-451.
[7]
Hoyer-Kuhn H, Kohbrok S, Volland R, et al. Vitamin b6 in primary hyperoxaluria I: first prospective trial after 40 years of practice[J]. Clin J Am Soc Nephrol, 2014, 9(3):468-477.
[8]
Conlon PJ, Little MA, Pieper K, et al. Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography[J]. Kidney Int, 2001, 60(4):1490-1497.
[9]
Mcclellan WM, Newsome BB, Mcclure LA, et al. Chronic kidney disease is often unrecognized among patients with coronary heart disease: The REGARDS Cohort Study[J]. Am J Nephrol, 2008, 29(1):10-17.
[10]
Kalra PA, Guo H, Kausz AT, et al. Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization, and prognosis[J]. Kidney Int, 2005, 68(1):293-301.
[11]
Conlon PJ, Athirakul K, Kovalik E, et al. Survival in renal vascular disease[J]. J Am Soc Nephrol, 1998, 9(2):252-256.
[12]
Chábová V, Schirger A, Stanson AW, et al. Outcomes of atherosclerotic renal artery stenosis managed without revascularization[J]. Mayo Clin Proc, 2000, 75(5):437-444.
[13]
Herrmann SMS, Saad A, Textor SC, et al. Management of atherosclerotic renovascular disease after Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL)[J]. Nephrology, 2014, 30(3):366-375.
[14]
Wang Y, Ho D, Chen WH, et al. Prevalence and predictors of renal artery stenosis in Chinese patients with coronary artery disease[J]. Int Med J, 2003, 33(7):280-285.
[15]
Hansen KJ, Edwards MS, Craven TE, et al. Prevalence of renovascular disease in the elderly: A population-based study[J]. J Vasc Surg, 2002, 36(3):443-451.
[16]
Olivieri O, Friso S, Trabetti E, et al. Homocysteine and atheromatous renal artery stenosis[J]. Clin Exp Med, 2001, 1(4):211-218.
[17]
Chen Z, Li J, Yang Y, et al. The renal artery is involved in Chinese arteritis patients[J]. Kidney Int, 2018, 93(1):30496-30499.
[18]
Chade AR, Rodriguez-Porcel M, Grande JP, et al. Distinct renal injury in early atherosclerosis and renovascular disease[J]. Circulation, 2002, 106(9):1165-1171.
[19]
Fananapazir G, McGahan JP, Corwin MT, et al. Screening for transplant renal artery stenosis: ultrasound -based stenosis probability stratification[J]. Am J Roentgenol, 2017, 209(5):1064-1073.
[20]
Lerman LO, Textor SC, Grande JP. Mechanisms of tissue injury in renal artery stenosis: Ischemia and beyond[J]. Prog Cardiovasc Dis, 2010, 52(3):196-203.
[21]
Vehkavaara S, Ykijärvinen H. 3.5 years of insulin therapy with insulin glargine improves in vivo endothelial function in type 2 diabetes[J]. Arterioscler Thromb Vasc Biol, 2004, 24(2):325-330.
[22]
Kotliar C, Juncos L, Inserra F, et al. Local and systemic cellular immunity in early renal artery atherosclerosis[J]. Clin J Am Soc Nephrol, 2012, 7(2):224-230.
[23]
Sun D, Eirin A, Ebrahimi B, et al. Early atherosclerosis aggravates renal microvascular loss and fibrosis in swine renal artery stenosis[J]. J Am Soc Hypertens, 2016, 10(4):325-335.
[24]
Preston RA, Jy W, Jimenez JJ, et al. Effects of severe hypertension on endothelial and platelet microparticles[J]. Hypertension, 2003, 41(2):211-217.
[25]
Franck G, Mawson T, Sausen G, et al. Flow perturbation mediates neutrophil recruitment and potentiates endothelial injury via TLR2 in mice: Implications for superficial erosion[J]. Circul Res, 2017, 121(1):31-42.
[26]
Caniffi C, Cerniello FM, Bouchet G, et al. Chronic treatment with C-type natriuretic peptide impacts differently in the aorta of normotensive and hypertensive rats[J]. Pflügers Arch, 2019, 471(8):1103-1115.
[27]
Zhang Y, Ge JB, Qian JY. Prevalence and risk factors of atherosclerotic renal artery stenosis in 1,200 Chinese patients undergoing coronary angiography[J]. Nephron Clin Pract, 104(4):c185-c192.
[1] 魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.
[2] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[3] 朱连华, 费翔, 韩鹏, 姜波, 李楠, 罗渝昆. 高帧频超声造影在胆囊息肉样病变中的鉴别诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 904-910.
[4] 张梅芳, 谭莹, 朱巧珍, 温昕, 袁鹰, 秦越, 郭洪波, 侯伶秀, 黄文兰, 彭桂艳, 李胜利. 早孕期胎儿头臀长正中矢状切面超声图像的人工智能质控研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 945-950.
[5] 陈舜, 薛恩生, 叶琴. PDCA在持续改进超声危急值管理制度中的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 974-978.
[6] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[7] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[8] 马艳波, 华扬, 刘桂梅, 孟秀峰, 崔立平. 中青年人颈动脉粥样硬化病变的相关危险因素分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 822-826.
[9] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 844-848.
[10] 张丽丽, 陈莉, 余美琴, 聂小艳, 王婧玲, 刘婷. PDCA循环法在超声浅表器官亚专科建设中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 717-721.
[11] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[12] 吴方园, 孙霞, 林昌锋, 张震生. HBV相关肝硬化合并急性上消化道出血的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 45-47.
[13] 陈旭渊, 罗仕云, 李文忠, 李毅. 腺源性肛瘘经手术治疗后创面愈合困难的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 82-85.
[14] 陆猛桂, 黄斌, 李秋林, 何媛梅. 蜂蛰伤患者发生多器官功能障碍综合征的危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1010-1015.
[15] 李达, 张大涯, 陈润祥, 张晓冬, 黄士美, 陈晨, 曾凡, 陈世锔, 白飞虎. 海南省东方市幽门螺杆菌感染现状的调查与相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 858-864.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号