Incidence and risk factors of atherosclerotic renal artery stenosis in elderly patients with refractory hypertension
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摘要:
目的 调查老年难治性高血压患者动脉粥样硬化性肾动脉狭窄(ARAS)的发病状况，并分析其危险因素，为临床早期诊治ARAS提供依据。 方法 回顾性分析2016年2月—2021年2月在西安交通大学第一附属医院心内科门诊就诊的老年难治性高血压患者216例的临床资料，根据肾动脉彩超和造影结果分为ARAS组(48例)和非ARAS组(168例)。比较2组临床资料，并分析患者发生ARAS的危险因素。 结果 216例患者肾动脉超声提示ARAS共62例(28.70%)，经肾动脉造影结果确诊ARAS共48例(22.22%)。ARAS组合并糖尿病、高脂血症、外周血管疾病、冠心病、肾功能不全比例分别为47.92%(23/48)、68.75%(33/48)、39.58%(19/48)、54.17%(26/48)、52.08%(25/48)，明显高于非ARAS组[30.36%(51/168)、51.19%(86/168)、18.45%(31/168)、34.52%(58/168)、26.79%(45/168)，均P＜0.05]；多因素logistic回归分析显示，合并外周血管疾病(OR=2.651, 95% CI：1.039~6.764)、肾功能不全(OR=2.713, 95% CI：1.106~6.656)是老年难治性高血压患者发生ARAS的独立危险因素。 结论 老年难治性高血压患者ARAS的发生率较高，合并外周血管疾病、肾功能不全是患者发生ARAS的独立危险因素。 Abstract:Objective To investigate the incidence of atherosclerotic renal artery stenosis (ARAS) in elderly patients with refractory hypertension and to analyse its risk factors, to provide evidence for the early clinical diagnosis and treatment of ARAS. Methods The clinical data of 216 elderly patients with refractory hypertension treated in the Cardiology Department of the First Affiliated Hospital of Xi ' an Jiaotong University from February 2016 to February 2021 were retrospectively analysed. According to the results of renal artery color Doppler ultrasonography and angiography, they were divided into ARAS (n=48) and non-ARAS (n=168) groups. The clinical data of the two groups were compared, and the risk factors for ARAS were analysed. Results In 216 patients, 62 cases (28.70%) were diagnosed as ARAS by renal arterial ultrasonography, and 48 cases (22.22%) were confirmed as ARAS by renal arteriography. The proportions of diabetes mellitus, hyperlipidemia, peripheral vascular disease, coronary heart disease, renal insufficiency in the ARAS group were 47.92% (23/48), 68.75% (33/48), 39.58% (19/48), 54.17% (26/48) and 52.08% (25/48), respectively, significantly higher than those in the non-ASAR group [30.36% (51/168), 51.19% (86/168), 18.45% (31/168), 34.52% (58/168) and 26.79% (45/168), respectively, all P < 0.05]. Multivariate logistic-regression analysis showed that peripheral vascular disease (OR=2.651, 95% CI: 1.039-6.764) and renal insufficiency (OR=2.713, 95% CI: 1.106-6.656) were independent risk factors for ARAS in elderly patients with refractory hypertension. Conclusion Elderly patients with refractory hypertension have a higher incidence of ARAS, and peripheral vascular disease and renal insufficiency are independent risk factors affecting ARAS occurrence. -
Key words:
- Refractory senile hypertension /
- Atherosclerosis /
- Renal artery stenosis /
- Risk factors
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表 1 2组老年难治性高血压患者相关临床资料比较
Table 1. Comparison of relevant clinical data in two groups of elderly patients with refractory hypertension
组别 例数 性别[例(%)] 年龄(x±s, 岁) 高血压病程(x±s, 年) 吸烟[例(%)] 糖尿病[例(%)] 男性 女性 有 无 有 无 ARAS组 48 26(54.17) 22(45.83) 68.69±1.58 15.63±2.53 11(22.92) 37(77.08) 23(47.92) 25(52.08) 非ARAS组 168 89(52.98) 79(47.02) 68.79±1.68 15.81±2.79 36(21.43) 132(78.57) 51(30.36) 117(69.64) 统计量 0.021a 0.368b 0.402b 0.049a 5.111a P值 0.884 0.713 0.688 0.826 0.024 组别 例数 高脂血症[例(%)] 外周血管疾病[例(%)] 冠心病[例(%)] 肾功能不全[例(%)] 高尿酸血症[例(%)] 有 无 有 无 有 无 有 无 有 无 ARAS组 48 33(68.75) 15(31.25) 19(39.58) 29(60.42) 26(54.17) 22(45.83) 25(52.08) 23(47.92) 8(16.67) 40(83.33) 非ARAS组 168 86(51.19) 82(48.81) 31(18.45) 137(81.55) 58(34.52) 110(65.48) 45(26.79) 123(73.21) 33(19.64) 135(80.36) 统计量 4.653a 9.371a 6.061a 10.907a 0.215a P值 0.031 0.002 0.014 0.001 0.643 注：a为χ2值，b为t值。 
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表 2 各变量赋值方法
Table 2. Methods of variable assignment
变量 赋值方法 糖尿病 无=0，有=1 高脂血症 无=0，有=1 外周血管疾病 无=0，有=1 冠心病 无=0，有=1 肾功能不全 无=0，有=1 ARAS 无=0，有=1
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表 3 老年难治性高血压患者ARAS影响因素的多因素logistic回归分析
Table 3. Multivariate logistic regression analysis of influencing factors of ARAS in elderly patients with refractory hypertension
变量 B SE Wald χ2 P值 OR值 95% CI 糖尿病 0.423 0.236 1.958 0.162 1.526 0.961~2.424 高脂血症 0.399 0.218 1.868 0.172 1.490 0.972~2.285 外周血管疾病 0.975 0.478 11.958 0.001 2.651 1.039~6.764 冠心病 0.449 0.241 2.195 0.138 1.567 0.977~2.512 肾功能不全 0.998 0.458 15.468 < 0.001 2.713 1.106~6.656
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