·临床研究·作者单位:200025上海瑞金医院心脏科单侧肾动脉狭窄患者肾静脉肾素活性的变化及意义张奇沈卫峰张瑞岩张建盛胡建张宪【摘要】目的探讨动脉粥样硬化性肾动脉狭窄患者肾静脉肾素活性变化及其和介入治疗后血压变化的关系。方法测定50例单侧肾动脉明显狭窄(管腔狭窄≥70%)患者肾动脉支架置入前双侧肾静脉和外周静脉肾素活性及血管紧张素Ⅱ浓度,分析其与肾动脉狭窄及支架术后血压变化的关系。结果同时伴有冠状动脉狭窄的患者成功接受冠状动脉及肾动脉血运重建术。狭窄侧肾静脉肾素平均活性明显高于对侧[狭窄侧(1144±1173)ng·ml-1·h-1和对照侧(1127±1157)ng·ml-1·h-1,P=0104],14例(28%)狭窄侧与对侧肾素活性比值≥115(肾血管性高血压组)。平均随访(12±9)个月,9例术后血压转为正常,其中肾血管性高血压组7例[50%,与对照组2例(6%)比较,P<01001]。多因素回归分析表明肾素活性比值≥115与肾动脉支架术后高血压治愈相关(风险比值OR=3115,95%CI为1149～5197,P=0102)。结论约三分之一动脉粥样硬化性肾动脉狭窄患者狭窄侧肾静脉肾素分泌显著增加(≥对侧115倍),这些患者中半数高血压在肾动脉支架术后可以治愈。【关键词】肾动脉;支架;肾素ChangesofrenalveinreninactivityinpatientswithunilateralartheroscleroticrenalarterystenosisZHANGQi,SHENWei2feng,ZHANGRui2yan,ZHANGJian2sheng,HUJian,ZHANGXian.DepartmentofCardiology,ShanghaiRuijinHospital,Shanghai200025,China【Abstract】ObjectiveToassessplasmareninactivity(PRA)ofrenalveinsinpatientswithunilateralrenalarteryartheroscleroticstenosisanditsrelationshipwithbloodpressurechangesafterrenalarterystenting1MethodsFiftypatientswithsignificantlyunilateralrenalarterystenosis(lumenloss≥70%)andcoronaryarterystenosiswereincluded1BilateralrenalveinandperipheralPRAandangiotensinⅡweredeterminedandtheirrelationswithbloodpressurechangesafterstentingwereanalyzed1ResultsAllpatientswererevascularizedsuccessfullyforbothcoronaryandrenalarterystenosis1PRAintheischemickidneywassignificantlyhigherthanthatinthecontralateralkidney(1144±1173ng·ml-1·h-1vs1127±1157ng·ml-1·h-1,P=0104)1Ischemicandcontralateralrenalveinreninratio(RVRR)was≥115in14patients(28%)(renalvascularhypertension,RVHgroup)1Duringfollow2up(12±9months),bloodpressurereturnedtonormalin9patientsafterrevascularization,7wereofRVHgroup(50%)and2wereincontrolgroup(6%)(P<01001)1MultivariatelogisticanalysisindicatedRVRR≥115wassignificantlyrelatedtothedecreaseofhypertensionafterrenalarterystenting(OR=3115,95%CI=1149～5197,P=0102)1ConclusionsPRAwassignificantlyincreasedintheischemickidneyinaboutone2thirdofpatientswithunilateralrenalarterystenosis1HypertensioncouldbecontrolledeasilytonormalvalueafterrenalarterystentinginhalfofthepatientswithRVRR≥1151Measurementofrenalveinreninactivityinpatientswithrenalarterystenosisisveryusefulinevaluatingtheeffectsofrenalarterystentingonhypertension1【Keywords】Renalartery;Stents;Renin肾素2血管紧张素2醛固酮系统(RAAS)与继发性高血压发病有密切的关系,5%～8%高血压患者由肾动脉狭窄引起(肾血管性高血压)[1]。严重肾动脉狭窄(管腔减小>70%)时,肾脏灌注压降低将刺激肾素生成增加,后者促进血管紧张素生成和醛固酮分泌增加,导致血管收缩、水钠潴留,血压增高[2]。临床常见的动脉粥样硬化性肾动脉狭窄是否为产生高血压的直接原因,还是包括原发性高血压、糖尿病、高血脂等多种因素综合作用的结果,尚未清楚。本研究旨在探讨这些患者肾静脉肾素分泌如何变化以及其对肾动脉支架术后疗效有无影响。资料与方法11病例选择:2002年6月至2003年4月在我·935·中华心血管病杂志2005年6月第33卷第6期ChinJCardiol,June2005,Vol.33No.6院就诊的50例冠状动脉及单侧肾动脉明显狭窄(管腔狭窄≥70%)患者,其中男性29例,女性21例,...
