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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(1.44±1.73)ng·ml-1·h-1和对照侧(1.27±1.57)ng·ml-1·h-1,P=0.04],14例(28%)狭窄侧与对侧肾素活性比值≥1.5(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<0.001]。多因素回归分析表明肾素活性比值≥1·5与肾动脉支架术后高血压治愈相关(风险比值OR=3.15,95%CI为1.49~5.97,P=0.02)。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1.5倍),这些患者中半数高血压在肾动脉支架术后可以治愈。
Objective To investigate the changes of renal renin activity in patients with atherosclerotic renal artery stenosis and its relationship with the changes of blood pressure after interventional therapy. Methods Renin activity and angiotensin Ⅱ concentration in bilateral renal vein and peripheral venous before renal artery stenting were measured in 50 patients with significant narrow stenosis (stenosis≥70%) in 50 patients with renal artery stenosis and stent Postoperative blood pressure changes. Results Patients with coronary artery stenosis were successfully treated with coronary artery and renal artery revascularization. The average activity of renin in the narrow side was significantly higher than that in the contralateral side (1.44 ± 1.73 ng · ml-1 · h-1 and 1.27 ± 1.57 ng · ml-1 · h-1 in the stenosis side, P = 0.04]. In 14 patients (28%), the ratio of stenosis to contralateral renin activity was ≥1.5 (renovascular hypertension group). After a mean follow-up of (12 ± 9) months, blood pressure was normal in 9 patients, including 7 in the group of renovascular hypertension [50% compared with 2 in the control group (6%), P <0.001]. Multivariate regression analysis showed that the ratio of renin activity ≥ 1.5 was related to the cure of hypertension after renal artery stenting (odds ratio OR = 3.15, 95% CI 1.49-5.97, P = 0.02). Conclusions Approximately one-third of patients with atherosclerotic renal artery stenosis showed a significant increase in renin secretion from the stenotic side of the renal vein (≥ 1.5-fold to the contralateral side) and half of these patients were cured after renal artery stenting.