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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,P<0.01];eGFR高于常规降脂组[(92.0±29.3)比(79.5±19.4)mL/(min·1.73 m~2),P<0.01],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),P<0.01];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,P<0.01]。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P>0.05)。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。
Objective To compare the effects of reinforcing lipid-lowering therapy with traditional lipid-lowering therapy on renal function after atherosclerotic renal artery stenosis. Methods A total of 150 hospitalized patients with atherosclerotic renal artery stenosis who were successfully undergone renal artery stenting from June 2013 to December 2014 were randomly assigned to intensive lipid-lowering group [LDL- C) target value <1.8mmol / L] and conventional lipid lowering group (LDL-C target value 1.8 ~ <3.3mmol / L). Both groups took rosuvastatin and adjusted LDL- The target value and maintained, the other treatment options between the two groups. The primary end point of the study was the estimated glomerular filtration rate (eGFR) and urinary albumin / creatinine at 6 months postoperatively. Secondary end points were the number of antihypertensive drugs, office blood pressure, stent restenosis, and cardiovascular clinical events at 6 months postoperatively. Results There was no significant difference in clinical baseline characteristics between the two groups. The level of LDL-C in intensive lipid-lowering group was significantly lower than that in conventional lipid-lowering group [(1.51 ± 0.32) vs (2.32 ± 0.47) mmol / L, P <0.01] 92.0 ± 29.3) (79.5 ± 19.4 mL / (min · 1.73 m 2), P <0.01]. The eGFR value was also significantly higher than that of the baseline lipid lowering group [16.7 (3.6-24.6) vs 1.5 9.5 ~ 8.7 mL / min ~ 1.73 m ~ 2, P <0.01]; urinary albumin / creatinine was lower than that of the conventional lipid lowering group [45.3 (19.8-64.0) vs 55.4 (26.0-121.8) mg / P = 0.037], and urine microalbumin / creatinine was lower than the baseline lipid lowering group [31.7 (2.3-54.4) -6.6 (-17.6-31.1) mg / g, P <0.01]. In the secondary end point, the number of antihypertensive drugs and clinic blood pressure in both groups were significantly decreased compared with the baseline level after the follow-up, but there was no significant difference between the two groups. The differences in the rate of stent restenosis and the major clinical events No statistical significance (all P> 0.05). Conclusion In patients with atherosclerotic renal artery stenosis, enhanced lipid-lowering after renal artery stenting may provide more renal protection than conventional lipid-lowering therapy.