| Background: At present, in the treatment of patients with atherosclerotic RenalArtery Stenosis, although the renal artery stenting has been widely used, but its stillhave not uniform surgical indication; The functions of improving the clinical effectsof hypertension and protection of renal are not sure, we still have to look for relatedfactors in preoperative effectively prejudging its results of operations, so that patientsget the most.Objective：Investigate the correlation between renin levels of peripheral vein and theprognosis of atherosclerotic Renal Artery Stenting and the hemodynamic parameterson the predictive value of he prognosis of atherosclerotic Renal Artery Stenting.Methods:1.49patients with unilateral or bilateral atherosclerotic renal arterystenosis in the General Hospital of PLA from Apirl2007to March2011were selected,All patients had unilateral or bilateral renal artery stenosis≥70%proved by renalarterial angiography and successfully underwent stenting. atherosclerosis risk factorswas recorded，Levels of plasma renin, angiotensin and aldosterone, blood pressure,the number of antihypertensive drugs, creatinine before and after operation wasmeasured. Blood pressure and serum creatinine levels were followed up in1,3and12months, finally,The correlation between renin levels of inferior vena cava and theprognosis of renal function after stenting was investigated.2.36patients with unilateral atherosclerotic renal artery stenosis concomitant withhypertension in the General Hospital of PLA from Apirl2008to September2012were selected; All patients had unilateral renal artery stenosis≥70%proved byangiography and successfully underwent renal arterial and stenting. Preoperativebaseline blood pressure levels and creatinine levels was recorded. Trans-stenoticpressure gradient across the constriction and pre-stenosis renal artery systolic pressure on different phases were measured before the operation. To benefit blood pressure andrenal function or not to determine the surgical benefit standards. The effectivenessand predictive value of PG and hemodynamic parameters as PG/preBP were analyzed.Results:1. According to preoperative and postoperative inferior vena cava reninlevels decline in value,Patients were divided into decline in value of renin>3ng/ml/hgroup and value <3ng/ml/h group. Those patients were fllowed up for average12months, It were observed that blood pressure, renin, angiotensin and aldosterone weresignificantly improved after the operation of renal artery stenting implantation andtended to be stable; In the two sets of Baseline characteristics of patients with>3ng/ml/h group suffer from high blood pressure less than3≤ng/ml/h Group (4.4±4.5vs8.3±7.6P<0.05); The renin and aldosterone of3≤ng/ml/h Group is higherthan before the surgery （renin：6.01±3.13VS3.23±2.7，aldosterone：0.73±0.43VS0.45±0.37P＜0.05）; there are significant differences in Blood pressure and eGFRbetween the two groups, respectively for the first month’ follow-up (SBP:137±22VS122±13,52.1±17.7ml/min vs38.3±17.5ml/min, P <0.05), third months’ follow-up(SBP:136±14vs124±11，eGFR：53.1±21.6ml/min vs41.7±16.6ml/min P＜0.05) andtwelfth months’ follow-up (SBP：137±17VS123±12，eGFR：51.7±19.0ml/min VS41.9±20.7ml/min P＜0.05);2. In every blood pressure phase, for the efficacy of renal artery stent implantation, theratio of PG/preBP have more predictive values than the simple PG. Divided by bloodpressure, the ROC curves of the ratio of PG/preBP has most under-curve area（0.796）,at the ratio>0.15, the sensitivity and specificity were0.896and0.547respectively;Divided by renal function, the ROC curves of the ratio of PG/preBP has mostunder-curve area（0.734）, at the ratio>0.17, the sensitivity and specificity were0.850and0.625respectively.conclusions1. Atherosclerotic renal artery stenosis stenting can reduce the level of the peripheralvein rennin.There has correlation between level of the Inferior vena cava and theprognosis of renal artery stenting.2. As hemodynamics parameters of the operation of atherosclerotic renal artery stenosis stent implantation, the PG/preBP have more predictive values than the PG.the average PG/preBP has most predictive values. The ratio that>0.15is a goodindication of stent implantation;... |
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