本文選題：粥樣硬化性腎動(dòng)脈狹窄 + 降脂治療　； 參考：《中華高血壓雜志》2017年03期

【摘要】：目的比較動(dòng)脈粥樣硬化性腎動(dòng)脈狹窄支架術(shù)后強(qiáng)化降脂與常規(guī)降脂治療對(duì)腎功能的影響是否存在差異。方法入選2013年6月至2014年12月成功行腎動(dòng)脈支架術(shù)的150例動(dòng)脈粥樣硬化性腎動(dòng)脈狹窄住院患者,1∶1隨機(jī)分配到強(qiáng)化降脂組[低密度脂蛋白膽固醇(LDL-C)目標(biāo)值1.8mmol/L]和常規(guī)降脂組(LDL-C目標(biāo)值1.8~3.3mmol/L),兩組均服用瑞舒伐他汀,在2個(gè)月內(nèi)調(diào)整LDL-C至各自的目標(biāo)值并維持,其他治療方案兩組間一致。研究主要終點(diǎn)為術(shù)后6個(gè)月的估算的腎小球?yàn)V過(guò)率(eGFR)和尿微量白蛋白/肌酐。次要終點(diǎn)為術(shù)后6個(gè)月的降壓藥物種數(shù)、診室血壓、支架再狹窄率和心血管臨床事件。結(jié)果兩組的臨床基線特征差異無(wú)統(tǒng)計(jì)學(xué)意義。術(shù)后6個(gè)月時(shí),強(qiáng)化降脂組LDL-C低于常規(guī)降脂組[(1.51±0.32)比(2.32±0.47)mmol/L,P0.01];eGFR高于常規(guī)降脂組[(92.0±29.3)比(79.5±19.4)mL/(min·1.73 m~2),P0.01],eGFR較基線升高值也高于常規(guī)降脂組[16.7(3.6~24.6)比1.5(-9.5~8.7)mL/(min·1.73 m~2),P0.01];尿微量白蛋白/肌酐低于常規(guī)降脂組[45.3(19.8~64.0)比55.4(26.0~121.8)mg/g,P=0.037],尿微量白蛋白/肌酐較基線下降值高于常規(guī)降脂組[31.7(2.3~54.4)比-6.6(-17.6~31.1)mg/g,P0.01]。次要終點(diǎn)方面,術(shù)后隨訪中兩組的降壓藥物種數(shù)和診室血壓較基線水平均有顯著下降,但組間差異無(wú)統(tǒng)計(jì)學(xué)意義,兩組支架再狹窄率及主要臨床事件的差異也無(wú)統(tǒng)計(jì)學(xué)意義(均P0.05)。結(jié)論粥樣硬化性腎動(dòng)脈狹窄患者在腎動(dòng)脈支架術(shù)后強(qiáng)化降脂較常規(guī)降脂可帶來(lái)更多腎功能保護(hù)作用。
[Abstract]:Objective to compare the effects of enhanced lipid-lowering and conventional lipid-lowering on renal function after stenting in atherosclerotic renal artery stenosis. Methods from June 2013 to December 2014, 150 inpatients with atherosclerotic renal artery stenosis were randomly assigned to the hyperlipidemic group [LDL-C target value 1.8mmol/L] and the patients underwent renal artery stenting successfully from June 2013 to December 2014. The target value of LDL-C in the conventional lipid-lowering group was 1.8 鹵3.3 mmol / L, and both groups were treated with rosuvastatin. LDL-C was adjusted to its target value and maintained within 2 months, and the other treatment protocols were consistent between the two groups. The main endpoints of the study were estimated glomerular filtration rate (GFR) and urinary albumin / creatinine at 6 months postoperatively. Secondary endpoints were the number of antihypertensive drugs, room blood pressure, stent restenosis rate, and cardiovascular events 6 months after operation. Results there was no significant difference in clinical baseline characteristics between the two groups. Six months after surgery, 寮哄寲闄嶈剛緇凩DL-C浣庝簬甯歌闄嶈剛緇刐(1.51鹵0.32)姣，

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