系统评价肾动脉狭窄的危险因素及与冠状动脉

发布时间：2019-04-24 06:38

【摘要】：背景及目的:肾动脉狭窄(Renal artery stenosis,RAS),是肾动脉疾病中常见的一大类。在我国,动脉粥样硬化所致的RAS,其发生率高达85%,危害也是最大的。一旦出现动脉粥样硬化,病情往往呈进行性加重。不仅可引起肾血管性高血压(Renal vascular hypertension,RVH),患肾缺血,在病变从狭窄进展至闭塞时,肾功能还会逐步恶化,一些患者也由此进入终末期肾病,对患者的生活质量和远期预后均会造成不良影响。故及时发现并干预动脉粥样硬化性肾动脉狭窄(Atherosclerotic Renal Artery Stenosis,ARAS)的进展至关重要。动脉粥样硬化是一种弥漫性的、全身性的血管疾病,常发生于中、大血管床内膜。目前,多个文献均报道,ARAS与冠状动脉病变(Coronary Artery Disease,CAD)密切相关。近年来,有人通过在行冠状动脉造影同时,行肾动脉造影,来提高RAS的发现率及诊断率,在一定程度上确实奏效。但若把该项检查作为RAS的筛选手段,可能会扩大该检查的适应范围,也可能导致介入相关并发症的发生;且费用昂贵,为侵入性操作,更不宜作为RAS诊断的常规检查项目。我们希望通过系统评价ARAS的相关危险因素,选择ARAS的高危患者行肾动脉造影,避免肾动脉造影的泛用。方法:本研究共两部分,第一部分为ARAS的传统危险因素及危险因素间危险强度差异的分析;第二部分为系统评价ARAS与CAD及周围动脉病(Peripheral Arterial Disease,PAD)的关系。第一部分1、检索数据库包括:CBM、PubMed、万方数据库、Web of science、知网数据库、VIP、EMBASE;2、检索时间:2013年10月之前;3、研究类型:公开发表的所有关于ARAS危险因素的病例对照研究;4、分别由两名研究者(刘波、吕建峰),逐一阅读并筛选文献,按照观察内容提取资料;5、根据nos量表对文献进行质量评价;6、采用revman5.2和stata11.0进行meta分析。第二部分1、检索数据库:pubmed、webofscience、thecochranelibrary和embase;2、检索时间:2014年04月之前;3、研究类型:公开发表的关于aras与cad及pad关系的病例对照研究;4、分别由两名研究者(刘波、吕建峰),仔细阅读并筛选文献,按照观察内容提取资料;5、根据nos量表对文献进行质量评价;6、采用revman5.2和stata11.0软件进行meta分析。结果:第一部分1、共17篇文献对病例组和对照组中性别进行探讨,纳入27247例患者,结果显示:其比值比和95%可信区间为1.31(1.21,1.42);2、共15篇文献对病例组和对照组中高血压进行探讨,纳入25062例患者,结果显示:其比值比和95%可信区间为2.42(2.18,2.67);3、共11篇文献对病例组和对照组中血脂异常进行探讨,纳入22612例患者,结果显示:其比值比和95%可信区间为1.55(1.18,2.05);4、共16篇文献对病例组和对照组中糖尿病进行探讨,纳入26718例患者,结果显示:其比值比和95%可信区间为1.44(1.31,1.58);5、共5篇文献对病例组和对照组中血压中的收缩压(systolicbloodpressure,sbp)进行探讨,纳入4553例患者,结果显示:其标准均数差和95%可信区间为11.08(5.01,17.16);6、共5篇文献对病例组和对照组中血压中的舒张压(diastolicbloodpressure,dbp)进行探讨,纳入4553例患者,结果显示:其标准均数差和95%可信区间为1.46(-3.09,6.10)。第二部分1、共9篇文献对病例组和对照组中cad的1支病变进行探讨,纳入8237例患者,结果显示:其比值比和95%可信区间为0.70(0.59,0.82);2、共9篇文献对病例组和对照组中CAD的2支病变进行探讨,纳入8237例患者,结果显示:其比值比和95%可信区间为1.28(1.10,1.48);3、共9篇文献对病例组和对照组中CAD的3支病变进行探讨,纳入8237例患者,结果显示:其比值比和95%可信区间为2.09(1.69,2.59);4、共7篇文献对病例组和对照组中CAD的LMCA病变进行探讨,纳入6522例患者,结果显示:其比值比和95%可信区间为1.82(1.40,2.36);5、共12篇文献对病例组和对照组中PAD进行探讨,纳入11639例患者,结果显示:其比值比和95%可信区间为3.68(2.21,6.10)。结论:第一部分女性、高血压、血脂异常、糖尿病、SBP是ARAS的危险因素,还不能认为DBP与ARAS的发病有关系。第二部分CAD中2支病变、3支病变、LMCA病变及PAD与ARAS相关,而CAD中1支病变与ARAS关系不大。
[Abstract]:Background and Objective: Renal artery stenosis (RAS) is a common type of renal artery disease. In China, the incidence of RAS, which is caused by atherosclerosis, is as high as 85%, and the harm is also the largest. In the event of atherosclerosis, the condition tends to be progressive. Renal vascular hypertension (RVH) can not only cause renal vascular hypertension (RVH), renal ischemia, but also in the progression of the disease from the stenosis to the occlusion, the renal function will also gradually deteriorate, and some patients will also enter the end-stage renal disease, and the quality of life and long-term prognosis of the patients will be adversely affected. Therefore, it is very important to find and intervene in the progression of the atherosclerotic renal artery stenosis (ARAS). Atherosclerosis is a diffuse, systemic vascular disease that often occurs in the middle and large vessels. At present, it is reported that ARAS is closely related to coronary artery disease (CAD). In recent years, the detection rate and the diagnostic rate of the RAS are improved by the addition of the coronary arteriography, and the rate of diagnosis and the diagnosis rate of the RAS can be improved to a certain extent. However, if the examination is taken as the screening means of the RAS, the adaptation scope of the examination may be expanded, and the occurrence of the related complications may also be caused; and the cost is expensive, it is an invasive operation, and it is not appropriate to be a routine check item for RAS diagnosis. We hope to evaluate the risk factors of the ARAS by the system, and select the renal arteriography of the high-risk patients of the ARAS, so as to avoid the general use of the renal arteriography. Methods: The first part is the analysis of the risk intensity difference between the traditional risk factors and the risk factors of the ARAS. The second part is the relationship between the ARAS and the CAD and the peripheral arterial disease (PAD) in the system. the first part 1, the retrieval database comprises: CBM, PubMed, Wanfang database, Web of science, knowledge network database, VIP, EMBASE,2, search time: before October 2013;3, type of study: all case-control studies on the risk factors of ARAS;4, The literature was read and screened one by one by two researchers (Liu Bo and Lu Jianfeng), and the data was extracted according to the observation content;5, the quality evaluation was carried out on the literature according to the nos.6, and the meta-analysis was performed by revman5.2 and stata11.0. The second part 1, the retrieval database: pubmed, webofscience, thecchyranibrry and embase;2, the search time: before 04,2014;3, the type of study: a case-control study on the relationship between aras and cad and pad; and 4, two researchers (liu bo, lu Jianfeng), respectively. The literature was carefully read and screened, and the data was extracted according to the observation contents;5, the quality evaluation was conducted on the literature according to the nos.6, and the meta-analysis was performed using the revman5.2 and the stata11.0 software. Results: In the first part, a total of 17 literatures were used to study the sex of the case group and the control group. The results showed that the odds ratio and the 95% confidence interval were 1.31 (1.21, 1.42);2,15 articles were used to study the hypertension in the case group and the control group, and the results showed that: The ratio ratio and the confidence interval of 95% were 2.42 (2.18, 2.67);3,11 articles were used to study the dyslipidemia in the case group and the control group, and the results showed that the ratio ratio and the 95% confidence interval were 1.55 (1.18, 2.05); and 4,16 articles discussed the diabetes in the case group and the control group. The results showed that the odds ratio and the 95% confidence interval were 1.44 (1.31, 1.58);5,5 of the total 5 articles discussed the systolic blood pressure (sbp) in the blood pressure in the case group and the control group, and included 4553 patients. The results showed that the standard mean difference and the 95% confidence interval were 11.08 (5.01, 17.16); and 6, Diastolic blood pressure (dbp) in the blood pressure in the case group and the control group was discussed in a total of 5 literatures. The results showed that the standard mean difference and the 95% confidence interval were 1.46 (-3.09, 6.10). In the second part, a total of 9 cases of cad in the case group and the control group were discussed and included in the 8237 patients. The results showed that the odds ratio and the 95% confidence interval were 0.70 (0.59, 0.82);2,9 articles discussed the 2 lesions of CAD in the case group and the control group, and included 8237 patients. The results showed that the odds ratio and the confidence interval of 95% were 1.28 (1.10, 1.48), and 3 cases of CAD in the case group and the control group were investigated by 9 articles. The results showed that the ratio ratio and the 95% confidence interval were 2.09 (1.69, 2.59); and 4. A total of 7 literatures were used to study the LMCA lesions of CAD in the case group and the control group. The results showed that the odds ratio and the 95% confidence interval were 1.82 (1.40, 2.36);5,12 articles were used to discuss the PAD in the case group and the control group and included the 11639 patients. The results showed that: The odds ratio and the 95% confidence interval are 3.68 (2.21, 6.10). Conclusion: The first part of women, hypertension, dyslipidemia, diabetes, SBP are the risk factors of ARAS, and the relationship between DBP and ARAS can not be considered. In the second part of CAD,2 lesions,3 lesions, LMCA lesions and PAD were associated with ARAS, and one lesion in CAD was not associated with ARAS.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R692.16

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