本文選題：腎動(dòng)脈粥樣硬化 + 腎動(dòng)脈狹窄性高血壓�。� 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的： 動(dòng)脈粥樣硬化性腎動(dòng)脈狹窄所致的腎性高血壓為繼發(fā)性高血壓的常見原因，腎動(dòng)脈粥樣硬化為全身動(dòng)脈粥樣硬化的一部分。本文旨在觀察抗動(dòng)脈硬化治療對此類高血壓患者腎動(dòng)脈狹窄程度的控制、相關(guān)動(dòng)脈粥樣硬化炎癥因子的改變及對腎臟的保護(hù)作用。 方法： 本研究主要是從炎癥因子水平探討應(yīng)用他汀類藥物強(qiáng)化降脂治療后1年后，腎動(dòng)脈狹窄的變化、相關(guān)動(dòng)脈粥樣硬化炎癥因子以及腎功能的改變。從2011年7月至2013年6月在本院心血管內(nèi)科、神經(jīng)內(nèi)科、腎病內(nèi)科住院治療的老年高血壓患者中行腎動(dòng)脈彩超檢查篩選腎動(dòng)脈狹窄患者，入選28人。常規(guī)給予降壓治療，血壓最好控制達(dá)標(biāo)（140/90mmHg）,如無禁忌，盡可能應(yīng)用ACEI或ARB類降壓藥物。給予入選患者他汀類降脂（立普妥10-60mg）治療，療程1年。服用1、3、6、12個(gè)月后分別測血脂、肌酐、MMP-2、MMP-9、CRP、ox-LDL，1、6、12個(gè)月后測肝功，12個(gè)月時(shí)復(fù)查腎動(dòng)脈彩超（于入選時(shí)選擇同一檢查方法，便于以同一標(biāo)準(zhǔn)評價(jià)）。每次復(fù)查時(shí)根據(jù)患者的LDL-C水平，調(diào)整立普妥用量至LDL-C水平降至2.6mmol/L以下或立普妥用量達(dá)到60mg/每天（非藥物說明中的最大劑量），調(diào)整劑量后1個(gè)月需進(jìn)行肝功檢查。如服用他汀類藥物出現(xiàn)輕度轉(zhuǎn)氨酶升高時(shí)可進(jìn)一步觀察，如升高3倍以上減量，如不能耐受加量則應(yīng)用調(diào)整用藥前的劑量繼續(xù)治療。如減量至（立普妥10mg/）每天,肝功仍升高3倍以上則停藥退組，并給與保肝藥物治療。應(yīng)用酶聯(lián)免疫吸附法（ELISA法），檢測動(dòng)脈粥樣硬化相關(guān)因子MMP-2、MMP-9、CRP、ox-LDL血清水平，并進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： 1、28例患者應(yīng)用阿托伐他�。⑵胀祝�12個(gè)月后，LDL與OX-LDL均下降；服藥12月后完成腎動(dòng)脈彩超隨訪的19例患者，LDL的降低與腎動(dòng)脈收縮期最大血流速度（PSV）、腎動(dòng)脈和腹主動(dòng)脈最大血流速度比（RAR）的降低采用pearson線性相關(guān)分析（R值分別為0.288，0.061；P值分別為0.023,0.048），，結(jié)果顯示LDL的降低與PSV、RAR的降低呈正相關(guān)；OX-LDL的降低與PSV、RAR的降低采用spearman秩相關(guān)（R值分別為0.250，0.121；P值分別為0.032,0.026），結(jié)果顯示OX-LDL的降低與PSV、RAR的降低呈正相關(guān)。提示隨著時(shí)間的強(qiáng)化降脂時(shí)間的延長，腎動(dòng)脈的血流速度有所降低。 2、根據(jù)入組患者0個(gè)月時(shí)腎動(dòng)脈彩超結(jié)果，（1）應(yīng)用腎動(dòng)脈血流參數(shù)PSV及RAR將其分為三組：第一組為：狹窄程度50%；第二組為：50%≤狹窄程度＜60%；第三組為：狹窄程度≥60%，三組患者進(jìn)行比較，患者血清MMP-2、MMP-9、CRP水平差異均無統(tǒng)計(jì)學(xué)意義（P0.05）；（2）通過采集病史，根據(jù)患者是否曾行冠狀動(dòng)脈造影檢查明確診斷為冠心病，將入組患者分為冠心病組和非冠心病組，兩組患者進(jìn)行比較，血清MMP-2、MMP-9、CRP水平差異均無統(tǒng)計(jì)學(xué)意義（P0.05）。 3、根據(jù)入組28例患者0個(gè)月時(shí)肌酐濃度值將患者分為基礎(chǔ)腎功能正常組和基礎(chǔ)腎功能異常組，兩組患者的eGFR值隨著用藥時(shí)間的延長均有所下降，各組內(nèi)患者eGFR濃度值在0、1、3、6、,12個(gè)月之間做比較，亦具有統(tǒng)計(jì)學(xué)差異（P0.05）。 4、28例患者0、1、3、6、12個(gè)月生化指標(biāo)（膽固醇、甘油三酯）及炎性因子（MMP-2、MMP-9、CRP、OX-LDL）均隨著用藥時(shí)間的延長有所下降，以上指標(biāo)在0、1、3、6、12個(gè)月時(shí)濃度的差異均具有統(tǒng)計(jì)學(xué)差異（P0.05）。 5、比較28例患者0、1、6、12個(gè)月時(shí)肝功能指標(biāo)，即谷丙轉(zhuǎn)氨酶（ALT)、谷草轉(zhuǎn)氨酶（AST)、肌酸激酶（CK)、肌酸激酶同工酶（CK-MB)的水平，隨著用藥時(shí)間的延長，以上反應(yīng)肝功能的指標(biāo)在0、1、6、12個(gè)月時(shí)濃度的差異無統(tǒng)計(jì)學(xué)差異（P0.05）。 結(jié)論： 強(qiáng)化他汀類藥物降脂治療不僅對腎動(dòng)脈粥樣硬化性狹窄有所控制而且對腎功能具有保護(hù)作用、安全性良好。
[Abstract]:Objective:
Renal hypertension caused by atherosclerotic renal artery stenosis is a common cause of secondary hypertension. Renal atherosclerosis is a part of systemic atherosclerosis. The purpose of this study is to observe the control of the degree of renal artery stenosis by anti arteriosclerosis treatment and the changes of inflammatory factors associated with atherosclerosis. And the protection of the kidney.
Method:
This study focuses on the changes in renal artery stenosis, related to atherosclerotic inflammatory factors and changes in renal function after 1 years of intensive lipid lowering treatment with statin drugs, from the July 2011 to June 2013 in the elderly hypertensive patients in the Department of cardiovascular medicine, neurology and nephrology. The renal artery color Doppler ultrasonography was used to select 28 patients with renal artery stenosis. The blood pressure was best controlled by the routine treatment. The blood pressure was best controlled by the standard (140/90mmHg). If no taboo, ACEI or ARB antihypertensive drugs were used. The statin lipid lowering (Lipitor 10-60mg) was given to the selected patients for 1 years. After 1,3,6,12 months, the blood lipid, creatinine, MMP- were measured respectively. 2, MMP-9, CRP, ox-LDL, 1,6,12 months after the test of liver function, 12 months after the reexamination of the renal artery color ultrasound (select the same examination method for the same criteria for evaluation). At the time of each reexamination, according to the patient's LDL-C level, the dosage of Lipitor to LDL-C level below 2.6mmol/L or the dosage of Lipitor to 60mg/ daily (non drug description) The maximum dose), 1 months after the adjustment of the dose, the liver function should be examined. If a statin is used for a mild transaminase increase, it can be further observed, such as an increase of more than 3 times, if the dosage is not tolerated, and the dosage before the use of the drug is continued. For example, the liver function still rises more than 3 times a day and the liver function is still raised more than 3 times. The serum levels of atherosclerotic related factors MMP-2, MMP-9, CRP and ox-LDL were detected by enzyme linked immunosorbent assay (ELISA), and the serum levels were analyzed with statistical analysis.
Result:
12 months after the use of atorvastatin (Lipitor) in 1,28 patients, both LDL and OX-LDL decreased, and 19 patients completed renal artery color Doppler follow-up after December. The decrease of LDL and the maximum velocity of renal artery systolic blood flow (PSV), and the decrease of the maximum blood flow velocity ratio (RAR) of the renal and abdominal aorta (RAR) were analyzed by Pearson linear correlation analysis (R value was 0, respectively). .288,0.061; P values are 0.023,0.048 respectively), and the results show that the decrease of LDL is positively correlated with the decrease of PSV and RAR; the decrease of OX-LDL and the decrease of PSV and RAR are associated with Spearman rank (R value is 0.250,0.121, respectively). The blood flow velocity of renal artery decreased with the prolongation of lipid time.
2, according to the results of renal artery color Doppler ultrasound at 0 months in the group, (1) the renal artery blood flow parameters PSV and RAR were divided into three groups: the first group was: the degree of stenosis was 50%; the second group was 50% or less of the stenosis degree < 60%; the third group was: the degree of stenosis was more than 60%, and the patients in the three group were compared. The difference of serum MMP-2, MMP-9, and CRP levels was not statistically significant. Learning significance (P0.05); (2) by collecting the medical history, according to whether the patients had been diagnosed as coronary artery coronary artery angiography, the patients were divided into coronary heart disease group and non coronary heart disease group, and the two groups were compared, the difference of serum MMP-2, MMP-9, and CRP level had no systematic significance (P0.05).
3, according to the concentration of creatinine at 0 months in the group of 28 patients, the patients were divided into normal group of basic renal function and abnormal renal function group. The eGFR value of the two groups decreased with the prolongation of the time of drug use. The concentration of eGFR in the patients in each group was 0,1,3,6, and the comparison between 12 months was also statistically significant (P0.05).
The 0,1,3,6,12 months biochemical indexes (cholesterol, triglyceride) and inflammatory factors (MMP-2, MMP-9, CRP, OX-LDL) in 4,28 patients were all decreased with the prolongation of the time of drug use, and the difference of the above indexes at 0,1,3,6,12 months was statistically significant (P0.05).
5, to compare the liver function indexes of 28 patients at 0,1,6,12 months, that is, the level of alanine aminotransferase (ALT), cereal transaminase (AST), creatine kinase (CK) and creatine kinase isoenzyme (CK-MB). With the prolongation of the time of drug use, there is no statistical difference in the concentration of liver function at 0,1,6,12 months (P0.05).
Conclusion:
Intensive statin lipid-lowering therapy can not only control renal atherosclerotic stenosis but also protect renal function and safety.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692;R544.1

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