| The first part:Risk factors analysis and dynamic blood pressure characteristics in patients with atherosclerotic renal artery stenosis and hypertensionBackground and objective:atherosclerotic renal artery stenosis is one of the important causes of secondary hypertension.With the continuous improvement of ultrasound,CT and other examination techniques,the detection rate of renal artery stenosis increases year by year,accounting for 0.5%to 5%of the hypertension population,of which the domestic incidence is about 1.93%.Progressive renal artery stenosis often leads to renal parenchymal ischemia,which leads to renal atrophy and seriously affects the long-term quality of life of patients.Current studies indicate that there is a strong similarity between renal artery stenosis and classic atherosclerosis risk factors.However,the effect of risk factors such as uric acid and inflammation on renal artery stenosis has not been reported.Dynamic blood pressure shows more obvious advantages in the diagnosis,treatment and evaluation of target organ damage of hypertension.The purpose of this study was to identify risk factors associated with atherosclerotic renal artery stenosis.Meanwhile,the blood pressure characteristics of patients with renal artery stenosis and hypertension were compared with those with primary hypertension by dynamic blood pressure monitoring.So as to provide the basis for evaluating the effect of treatment.Objects and methods:the research object is in the anzhen hospital affiliated to the capital university of medical sciences,the renal artery ultrasound findings of renal artery stenosis greater than 50%of the total of 128 patients with hypertension,general clinical data of these patients,through gathering way through the frequency ratio of 1:1 to collect anzhen hospital outpatient in gender,age,matching the 128 cases of patients with essential hypertension(eh),USES the independent t test,analysis of covariance,chi-square test,single factor and multiple factors logistic regression analysis of renal artery stenosis and the general information of patients with essential hypertension(eh).Bilateral test was used for all statistical tests,and p<0.05 was considered statistically significant.Results:compared with patients with primary hypertension,patients with renal artery stenosis had elevated triglycerides(1.9),total cholesterol(4.87),monocyte percentage(6.17%),mean platelet volume(10.78),platelet distribution width(13.04),and monocyte/HDL ratio(0.41)(p<0.05).Uni variate logistic regression analysis showed that LDL,triglycerides,total cholesterol,nucleocyte percentage,mean platelet volume,platelet distribution width,and monocyte/HDL ratio were associated with renal artery stenosis.Variables were put into the regression equation,where monocyte percentage and monocyte/HDL ratio were positively correlated with renal artery stenosis(=0.385,0.512).HDL was negatively associated with renal artery stenosis(=-3.017).The patients with atherosclerotic renal artery stenosis and hypertension had a higher average body mass index(25.7),more antihypertensive drugs(1.9)and more complications.In the case of increased types of drugs,the 24-hour mean blood pressure of the renal artery stenosis group was still significantly higher than that of the patients with primary hypertension(138.3mmHgvsl28.1mmHg),and the mean heart rate of the renal artery stenosis group(80.0 times/min)was significantly different from that of the patients with primary hypertension(66.9 times/min).In addition,the nocturnal blood pressure drop rate of the renal artery stenosis group was significantly lower than that of the patients with primary hypertension(8.92%vs14.52%),presenting a non-spoon type.Conclusions:monocyte percentage,high-density lipoprotein,monocyte/high-density lipoprotein ratio are the predictors of renal artery stenosis,which can provide information for the clinical detection of susceptible population and the prevention of renal artery stenosis.Compared with patients with primary hypertension,the blood pressure of patients with renal artery stenosis was significantly increased at 24H,and the rate of nocturnal blood pressure drop was significantly decreased,presenting non-spoon type blood pressure.The second part:TCM symptoms in patients with atherosclerotic renal artery stenosis and hypertensionBackground and objective:the treatment of atherosclerotic renal artery stenosis includes drug therapy and surgery.At present,studies have pointed out that strict control of atherosclerosis risk factors has important significance for vascular protection,such as control of blood pressure,blood sugar and lipid levels.Recent studies have shown that active blood pressure reduction and statin lipid lowering can improve the survival rate of patients and reduce the risk of disease progression.Traditional Chinese medicine(TCM)has potential advantages in the prevention and treatment of atherosclerotic renal artery stenosis.Some domestic studies indicated that statin combined with traditional Chinese medicine can effectively protect endothelial cells and inhibit the occurrence and development of renal artery stenosis.However,the etiology,pathogenesis and symptom distribution of atherosclerotic renal artery stenosis are still in their infancy.The purpose of this study was to investigate the symptom score of patients with atherosclerotic renal artery stenosis and to explore the symptom characteristics of patients with renal artery stenosis and hypertension.Objects and methods:the research object is in the anzhen hospital affiliated to the capital university of medical sciences,the renal artery ultrasound findings of renal artery stenosis greater than 50%of the total of 128 patients with hypertension,through collection and general clinical data of these patients,and clinical symptoms integral,USES the independent t test,analysis of covariance and chi-square test for renal artery stenosis patients with high blood pressure,the general test data and clinical symptoms.Bilateral test was used for all statistical tests,and p<0.05 was considered statistically significant.Results:among 128 patients with renal artery stenosis and hypertension,the common symptoms were fatigue,short chest stuffy breath,dizziness and headache,long nocturia,insomnia and edema.The most common deficiency syndrome is Yin deficiency syndrome,and the most common pathogenic syndrome is dampness and heat syndrome.There was a positive correlation between deficiency syndrome score and pathogenic empirical score in patients with renal artery stenosis and hypertension,suggesting that the pathogenesis of patients with renal artery stenosis and hypertension was characterized by underlying deficiency and excess.Conclusion:the syndrome type of renal artery stenosis is characterized by deficiency and excess,and Yin deficiency is the most common syndrome type.It is characterized by more dampness and more blood stasis.The method of invigorating qi,activating blood and benefiting dampness may achieve better clinical effect in patients with renal artery stenosis and hypertension. |
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