| Objective:To investigate the population characteristics,risk factors of patients with Renal artery stenosis(RAS),evaluate the efficacy of interventional therapy and jugular drug therapy alone,and compare the prognosis,so as to provide reference for screening and treatment of RAS patients.Methods:A total of 413 patients who met the inclusion and exclusion criteria and were admitted to the inpatient department of our hospital from December 1,2011 to December 31,2021 with complete follow-up data were selected as the RAS group.In addition,patients who received renal artery color ultrasound during the same period with no obvious abnormalities and complete other clinical data were randomly selected.A total of 413 subjects served as the control group for retrospective analysis.Clinical case data(including patient demographics,previous history,personal history,clinical symptoms,combined underlying diseases,RAS etiology,laboratory indicators,imaging data)and follow-up data(blood pressure and antihypertensive drugs used in outpatient or telephone follow-up)required for analysis were collected.Statistical software was used to analyze and compare the population characteristics,risk factors and prognosis of RAS disease under different treatment plans,and to evaluate the effectiveness of interventional therapy and drug therapy alone.Results:A total of 413 patients with RAS were diagnosed in our hospital in the past ten years,including 251 males(60.8%)and 162 females(39.2%).The mean age of treatment was62.24±13.29 years old.380 patients(92.0%)had hypertension(systolic blood pressure was153.79±26.57 mm Hg,diastolic blood pressure was 90.07±16.78 mm Hg),the number of antihypertensive drugs was 1.38±0.97,and 198 patients(47.9%)were smoking,the proportion of males was higher than females(86.9%vs13.1%).The patients with atherosclerotic renal artery stenosis(ARAS)were older,male,smoking,diabetes,coronary heart disease,stroke,and peripheral vascular disease were more common in the ARAS group(P<0.05),and the patients in the myofibrous dysplasia group(FMD)and aortitis group(TA)were younger.There were significant differences in age,smoking history,hypertension,myocardial infarction,angina,stroke,carotid artery plaque,subclavian artery plaque,heart failure and peripheral vascular disease between RAS group and control group(P<0.05).In laboratory results,troponin T,homocysteine,cystatin C,blood urea and serum creatinine were significantly different among groups(P<0.05).Compared with renal artery ultrasound data,the systolic peak velocity of renal artery,abdominal aorta velocity,ratio of renal artery to abdominal aorta peak velocity,ratio of renal artery to interlobular artery peak velocity,renal artery resistance index and interlobular artery resistance index in RAS group were significantly higher than those in control group(P<0.05).Compared with the echocardiography data,the posterior wall thickness of the left ventricle and the velocity of the aortic opening in the RAS group were significantly higher than those in the control group,and the LVEF in the control group was higher than that in the RAS group(P<0.05).Multivariate logistic regression analysis showed that age(OR: 1.024;95%CI:1.006-1.043),history of hypertension(OR: 4.813;95%CI: 2.512 ～ 9.223),carotid artery plaque(OR: 3.016;95%CI: 1.735-5.243),subclavian artery plaque(OR: 2.269;95%CI: 1.434～ 3.589),heart failure(OR: 4.523;95%CI: 1.662-12.310),peripheral vascular disease(OR:1.607;95%CI: 1.021 ～ 2.531),homocysteine(OR: 1.032;95%CI: 1.003 ～ 1.063),SCys C(OR: 4.789;95%CI: 2.202 ～ 10.419)was an independent predictor of RAS occurrence.The ROC curve analysis showed that the area under the curve was 0.726 and the best cut-off was 59.5 years old.The sensitivity and specificity of RAS were 65.7% and 71.6%respectively.When the area under the curve of homocysteine was 0.742 and the optimum cut-off was 14.685umol/l,the sensitivity and specificity were 78.4% and 63.0%.The sensitivity and specificity of SCys C were 67.8% and 80.2% when the area under the curve was 0.770 and the optimal cut-off was 0.965mg/L.Among the 120 patients with RAS who received interventional therapy,the success rate of menorrhea revasectomy was 100%,and the incidence rate of operation-related complications was 2.5%.They were divided into the simple drug group and the interventional group according to different RAS treatment plans,and the clinical baseline data were basically consistent and comparable between the two groups before treatment.In the severe stenosis group,the reduction of systolic blood pressure in the interventional therapy group was significantly higher than that in the drug therapy group alone,and the types of antihypertensive drugs used were significantly lower than that in the drug group(P<0.05).In the moderate stenosis group,the reduction of systolic blood pressure and diastolic blood pressure in the interventional therapy group was significantly higher than that in the drug therapy group alone,and the types of antihypertensive drugs used were significantly lower than that in the drug group alone(P<0.05).In the mild stenosis group,the reduction of systolic blood pressure(P=0.624)and diastolic blood pressure(P=0.286)in the interventional treatment group was higher than that in the drug treatment group alone,and the types of antihypertensive drugs used were lower than that in the drug group(P=0.675),but no statistical significance was found.In general,the average systolic blood pressure in the single drug treatment group was significantly lower than before intervention,and the types of antihypertensive drugs were significantly increased,both of which had statistical significance(P<0.05).The average diastolic blood pressure was not significantly changed compared with before intervention,and the effective rate was 22.9%.The mean systolic blood pressure and mean diastolic blood pressure in the interventional treatment group were significantly lower than the baseline level,with statistical significance(P<0.05).The types of antihypertensive drugs had no significant changes compared with the preoperative treatment,and the effective rate was 37.5%,which was higher in the interventional treatment group.Conclusion:1.The ARAS group accounted for the highest proportion of RAS patients(88.9%),and they were older;male,smoking,diabetes,coronary heart disease,stroke and peripheral vascular disease were more common in the ARAS group;FMD and TA patients were younger,and the female group accounted for the highest proportion(85.7%).2.Age,history of hypertension,carotid artery plaque,subclavian artery plaque,heart failure,peripheral vascular disease,homocysteine and SCys C are closely related to the occurrence of RAS.They are independent risk factors for the occurrence of RAS and can be used as predictors of the occurrence of RAS,among which SCys Chas a better predictive ability.3.Interventional therapy is one of the effective methods for the treatment of RAS patients with different etiology.The incidence of complications is small,which can effectively control blood pressure and reduce the types of antihypertensive drugs used,among which the moderate and severe stenosis has significant effect. |
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