动脉粥样硬化性肾动脉狭窄支架术后强化降脂或常规降脂治疗对肾功能的影响:一项前瞻性随机对照研究

发布时间：2018-05-22 20:29

  本文选题：粥样硬化性肾动脉狭窄 + 降脂治疗　； 参考：《中华高血压杂志》2017年03期

【摘要】：目的比较动脉粥样硬化性肾动脉狭窄支架术后强化降脂与常规降脂治疗对肾功能的影响是否存在差异。方法入选2013年6月至2014年12月成功行肾动脉支架术的150例动脉粥样硬化性肾动脉狭窄住院患者,1∶1随机分配到强化降脂组[低密度脂蛋白胆固醇(LDL-C)目标值1.8mmol/L]和常规降脂组(LDL-C目标值1.8~3.3mmol/L),两组均服用瑞舒伐他汀,在2个月内调整LDL-C至各自的目标值并维持,其他治疗方案两组间一致。研究主要终点为术后6个月的估算的肾小球滤过率(eGFR)和尿微量白蛋白/肌酐。次要终点为术后6个月的降压药物种数、诊室血压、支架再狭窄率和心血管临床事件。结果两组的临床基线特征差异无统计学意义。术后6个月时,强化降脂组LDL-C低于常规降脂组[(1.51±0.32)比(2.32±0.47)mmol/L,P0.01];eGFR高于常规降脂组[(92.0±29.3)比(79.5±19.4)mL/(min·1.73 m~2),P0.01],eGFR较基线升高值也高于常规降脂组[16.7(3.6~24.6)比1.5(-9.5~8.7)mL/(min·1.73 m~2),P0.01];尿微量白蛋白/肌酐低于常规降脂组[45.3(19.8~64.0)比55.4(26.0~121.8)mg/g,P=0.037],尿微量白蛋白/肌酐较基线下降值高于常规降脂组[31.7(2.3~54.4)比-6.6(-17.6~31.1)mg/g,P0.01]。次要终点方面,术后随访中两组的降压药物种数和诊室血压较基线水平均有显著下降,但组间差异无统计学意义,两组支架再狭窄率及主要临床事件的差异也无统计学意义(均P0.05)。结论粥样硬化性肾动脉狭窄患者在肾动脉支架术后强化降脂较常规降脂可带来更多肾功能保护作用。
[Abstract]:Objective to compare the effects of enhanced lipid-lowering and conventional lipid-lowering on renal function after stenting in atherosclerotic renal artery stenosis. Methods from June 2013 to December 2014, 150 inpatients with atherosclerotic renal artery stenosis were randomly assigned to the hyperlipidemic group [LDL-C target value 1.8mmol/L] and the patients underwent renal artery stenting successfully from June 2013 to December 2014. The target value of LDL-C in the conventional lipid-lowering group was 1.8 卤3.3 mmol / L, and both groups were treated with rosuvastatin. LDL-C was adjusted to its target value and maintained within 2 months, and the other treatment protocols were consistent between the two groups. The main endpoints of the study were estimated glomerular filtration rate (GFR) and urinary albumin / creatinine at 6 months postoperatively. Secondary endpoints were the number of antihypertensive drugs, room blood pressure, stent restenosis rate, and cardiovascular events 6 months after operation. Results there was no significant difference in clinical baseline characteristics between the two groups. Six months after surgery, 寮哄寲闄嶈剛缁凩DL-C浣庝簬甯歌�勯檷鑴傜粍[(1.51卤0.32)姣，

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