系統(tǒng)評(píng)價(jià)腎動(dòng)脈狹窄的危險(xiǎn)因素及與冠狀動(dòng)脈
發(fā)布時(shí)間：2019-04-24 06:38
【摘要】：背景及目的:腎動(dòng)脈狹窄(Renal artery stenosis,RAS),是腎動(dòng)脈疾病中常見(jiàn)的一大類(lèi)。在我國(guó),動(dòng)脈粥樣硬化所致的RAS,其發(fā)生率高達(dá)85%,危害也是最大的。一旦出現(xiàn)動(dòng)脈粥樣硬化,病情往往呈進(jìn)行性加重。不僅可引起腎血管性高血壓(Renal vascular hypertension,RVH),患腎缺血,在病變從狹窄進(jìn)展至閉塞時(shí),腎功能還會(huì)逐步惡化,一些患者也由此進(jìn)入終末期腎病,對(duì)患者的生活質(zhì)量和遠(yuǎn)期預(yù)后均會(huì)造成不良影響。故及時(shí)發(fā)現(xiàn)并干預(yù)動(dòng)脈粥樣硬化性腎動(dòng)脈狹窄(Atherosclerotic Renal Artery Stenosis,ARAS)的進(jìn)展至關(guān)重要。動(dòng)脈粥樣硬化是一種彌漫性的、全身性的血管疾病,常發(fā)生于中、大血管床內(nèi)膜。目前,多個(gè)文獻(xiàn)均報(bào)道,ARAS與冠狀動(dòng)脈病變(Coronary Artery Disease,CAD)密切相關(guān)。近年來(lái),有人通過(guò)在行冠狀動(dòng)脈造影同時(shí),行腎動(dòng)脈造影,來(lái)提高RAS的發(fā)現(xiàn)率及診斷率,在一定程度上確實(shí)奏效。但若把該項(xiàng)檢查作為RAS的篩選手段,可能會(huì)擴(kuò)大該檢查的適應(yīng)范圍,也可能導(dǎo)致介入相關(guān)并發(fā)癥的發(fā)生;且費(fèi)用昂貴,為侵入性操作,更不宜作為RAS診斷的常規(guī)檢查項(xiàng)目。我們希望通過(guò)系統(tǒng)評(píng)價(jià)ARAS的相關(guān)危險(xiǎn)因素,選擇ARAS的高危患者行腎動(dòng)脈造影,避免腎動(dòng)脈造影的泛用。方法:本研究共兩部分,第一部分為ARAS的傳統(tǒng)危險(xiǎn)因素及危險(xiǎn)因素間危險(xiǎn)強(qiáng)度差異的分析;第二部分為系統(tǒng)評(píng)價(jià)ARAS與CAD及周?chē)鷦?dòng)脈病(Peripheral Arterial Disease,PAD)的關(guān)系。第一部分1、檢索數(shù)據(jù)庫(kù)包括:CBM、PubMed、萬(wàn)方數(shù)據(jù)庫(kù)、Web of science、知網(wǎng)數(shù)據(jù)庫(kù)、VIP、EMBASE;2、檢索時(shí)間:2013年10月之前;3、研究類(lèi)型:公開(kāi)發(fā)表的所有關(guān)于ARAS危險(xiǎn)因素的病例對(duì)照研究;4、分別由兩名研究者(劉波、呂建峰),逐一閱讀并篩選文獻(xiàn),按照觀察內(nèi)容提取資料;5、根據(jù)nos量表對(duì)文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià);6、采用revman5.2和stata11.0進(jìn)行meta分析。第二部分1、檢索數(shù)據(jù)庫(kù):pubmed、webofscience、thecochranelibrary和embase;2、檢索時(shí)間:2014年04月之前;3、研究類(lèi)型:公開(kāi)發(fā)表的關(guān)于aras與cad及pad關(guān)系的病例對(duì)照研究;4、分別由兩名研究者(劉波、呂建峰),仔細(xì)閱讀并篩選文獻(xiàn),按照觀察內(nèi)容提取資料;5、根據(jù)nos量表對(duì)文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià);6、采用revman5.2和stata11.0軟件進(jìn)行meta分析。結(jié)果:第一部分1、共17篇文獻(xiàn)對(duì)病例組和對(duì)照組中性別進(jìn)行探討,納入27247例患者,結(jié)果顯示:其比值比和95%可信區(qū)間為1.31(1.21,1.42);2、共15篇文獻(xiàn)對(duì)病例組和對(duì)照組中高血壓進(jìn)行探討,納入25062例患者,結(jié)果顯示:其比值比和95%可信區(qū)間為2.42(2.18,2.67);3、共11篇文獻(xiàn)對(duì)病例組和對(duì)照組中血脂異常進(jìn)行探討,納入22612例患者,結(jié)果顯示:其比值比和95%可信區(qū)間為1.55(1.18,2.05);4、共16篇文獻(xiàn)對(duì)病例組和對(duì)照組中糖尿病進(jìn)行探討,納入26718例患者,結(jié)果顯示:其比值比和95%可信區(qū)間為1.44(1.31,1.58);5、共5篇文獻(xiàn)對(duì)病例組和對(duì)照組中血壓中的收縮壓(systolicbloodpressure,sbp)進(jìn)行探討,納入4553例患者,結(jié)果顯示:其標(biāo)準(zhǔn)均數(shù)差和95%可信區(qū)間為11.08(5.01,17.16);6、共5篇文獻(xiàn)對(duì)病例組和對(duì)照組中血壓中的舒張壓(diastolicbloodpressure,dbp)進(jìn)行探討,納入4553例患者,結(jié)果顯示:其標(biāo)準(zhǔn)均數(shù)差和95%可信區(qū)間為1.46(-3.09,6.10)。第二部分1、共9篇文獻(xiàn)對(duì)病例組和對(duì)照組中cad的1支病變進(jìn)行探討,納入8237例患者,結(jié)果顯示:其比值比和95%可信區(qū)間為0.70(0.59,0.82);2、共9篇文獻(xiàn)對(duì)病例組和對(duì)照組中CAD的2支病變進(jìn)行探討,納入8237例患者,結(jié)果顯示:其比值比和95%可信區(qū)間為1.28(1.10,1.48);3、共9篇文獻(xiàn)對(duì)病例組和對(duì)照組中CAD的3支病變進(jìn)行探討,納入8237例患者,結(jié)果顯示:其比值比和95%可信區(qū)間為2.09(1.69,2.59);4、共7篇文獻(xiàn)對(duì)病例組和對(duì)照組中CAD的LMCA病變進(jìn)行探討,納入6522例患者,結(jié)果顯示:其比值比和95%可信區(qū)間為1.82(1.40,2.36);5、共12篇文獻(xiàn)對(duì)病例組和對(duì)照組中PAD進(jìn)行探討,納入11639例患者,結(jié)果顯示:其比值比和95%可信區(qū)間為3.68(2.21,6.10)。結(jié)論:第一部分女性、高血壓、血脂異常、糖尿病、SBP是ARAS的危險(xiǎn)因素,還不能認(rèn)為DBP與ARAS的發(fā)病有關(guān)系。第二部分CAD中2支病變、3支病變、LMCA病變及PAD與ARAS相關(guān),而CAD中1支病變與ARAS關(guān)系不大。
[Abstract]:Background and Objective: Renal artery stenosis (RAS) is a common type of renal artery disease. In China, the incidence of RAS, which is caused by atherosclerosis, is as high as 85%, and the harm is also the largest. In the event of atherosclerosis, the condition tends to be progressive. Renal vascular hypertension (RVH) can not only cause renal vascular hypertension (RVH), renal ischemia, but also in the progression of the disease from the stenosis to the occlusion, the renal function will also gradually deteriorate, and some patients will also enter the end-stage renal disease, and the quality of life and long-term prognosis of the patients will be adversely affected. Therefore, it is very important to find and intervene in the progression of the atherosclerotic renal artery stenosis (ARAS). Atherosclerosis is a diffuse, systemic vascular disease that often occurs in the middle and large vessels. At present, it is reported that ARAS is closely related to coronary artery disease (CAD). In recent years, the detection rate and the diagnostic rate of the RAS are improved by the addition of the coronary arteriography, and the rate of diagnosis and the diagnosis rate of the RAS can be improved to a certain extent. However, if the examination is taken as the screening means of the RAS, the adaptation scope of the examination may be expanded, and the occurrence of the related complications may also be caused; and the cost is expensive, it is an invasive operation, and it is not appropriate to be a routine check item for RAS diagnosis. We hope to evaluate the risk factors of the ARAS by the system, and select the renal arteriography of the high-risk patients of the ARAS, so as to avoid the general use of the renal arteriography. Methods: The first part is the analysis of the risk intensity difference between the traditional risk factors and the risk factors of the ARAS. The second part is the relationship between the ARAS and the CAD and the peripheral arterial disease (PAD) in the system. the first part 1, the retrieval database comprises: CBM, PubMed, Wanfang database, Web of science, knowledge network database, VIP, EMBASE,2, search time: before October 2013;3, type of study: all case-control studies on the risk factors of ARAS;4, The literature was read and screened one by one by two researchers (Liu Bo and Lu Jianfeng), and the data was extracted according to the observation content;5, the quality evaluation was carried out on the literature according to the nos.6, and the meta-analysis was performed by revman5.2 and stata11.0. The second part 1, the retrieval database: pubmed, webofscience, thecchyranibrry and embase;2, the search time: before 04,2014;3, the type of study: a case-control study on the relationship between aras and cad and pad; and 4, two researchers (liu bo, lu Jianfeng), respectively. The literature was carefully read and screened, and the data was extracted according to the observation contents;5, the quality evaluation was conducted on the literature according to the nos.6, and the meta-analysis was performed using the revman5.2 and the stata11.0 software. Results: In the first part, a total of 17 literatures were used to study the sex of the case group and the control group. The results showed that the odds ratio and the 95% confidence interval were 1.31 (1.21, 1.42);2,15 articles were used to study the hypertension in the case group and the control group, and the results showed that: The ratio ratio and the confidence interval of 95% were 2.42 (2.18, 2.67);3,11 articles were used to study the dyslipidemia in the case group and the control group, and the results showed that the ratio ratio and the 95% confidence interval were 1.55 (1.18, 2.05); and 4,16 articles discussed the diabetes in the case group and the control group. The results showed that the odds ratio and the 95% confidence interval were 1.44 (1.31, 1.58);5,5 of the total 5 articles discussed the systolic blood pressure (sbp) in the blood pressure in the case group and the control group, and included 4553 patients. The results showed that the standard mean difference and the 95% confidence interval were 11.08 (5.01, 17.16); and 6, Diastolic blood pressure (dbp) in the blood pressure in the case group and the control group was discussed in a total of 5 literatures. The results showed that the standard mean difference and the 95% confidence interval were 1.46 (-3.09, 6.10). In the second part, a total of 9 cases of cad in the case group and the control group were discussed and included in the 8237 patients. The results showed that the odds ratio and the 95% confidence interval were 0.70 (0.59, 0.82);2,9 articles discussed the 2 lesions of CAD in the case group and the control group, and included 8237 patients. The results showed that the odds ratio and the confidence interval of 95% were 1.28 (1.10, 1.48), and 3 cases of CAD in the case group and the control group were investigated by 9 articles. The results showed that the ratio ratio and the 95% confidence interval were 2.09 (1.69, 2.59); and 4. A total of 7 literatures were used to study the LMCA lesions of CAD in the case group and the control group. The results showed that the odds ratio and the 95% confidence interval were 1.82 (1.40, 2.36);5,12 articles were used to discuss the PAD in the case group and the control group and included the 11639 patients. The results showed that: The odds ratio and the 95% confidence interval are 3.68 (2.21, 6.10). Conclusion: The first part of women, hypertension, dyslipidemia, diabetes, SBP are the risk factors of ARAS, and the relationship between DBP and ARAS can not be considered. In the second part of CAD,2 lesions,3 lesions, LMCA lesions and PAD were associated with ARAS, and one lesion in CAD was not associated with ARAS.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R692.16
本文編號(hào)：2464190
[Abstract]:Background and Objective: Renal artery stenosis (RAS) is a common type of renal artery disease. In China, the incidence of RAS, which is caused by atherosclerosis, is as high as 85%, and the harm is also the largest. In the event of atherosclerosis, the condition tends to be progressive. Renal vascular hypertension (RVH) can not only cause renal vascular hypertension (RVH), renal ischemia, but also in the progression of the disease from the stenosis to the occlusion, the renal function will also gradually deteriorate, and some patients will also enter the end-stage renal disease, and the quality of life and long-term prognosis of the patients will be adversely affected. Therefore, it is very important to find and intervene in the progression of the atherosclerotic renal artery stenosis (ARAS). Atherosclerosis is a diffuse, systemic vascular disease that often occurs in the middle and large vessels. At present, it is reported that ARAS is closely related to coronary artery disease (CAD). In recent years, the detection rate and the diagnostic rate of the RAS are improved by the addition of the coronary arteriography, and the rate of diagnosis and the diagnosis rate of the RAS can be improved to a certain extent. However, if the examination is taken as the screening means of the RAS, the adaptation scope of the examination may be expanded, and the occurrence of the related complications may also be caused; and the cost is expensive, it is an invasive operation, and it is not appropriate to be a routine check item for RAS diagnosis. We hope to evaluate the risk factors of the ARAS by the system, and select the renal arteriography of the high-risk patients of the ARAS, so as to avoid the general use of the renal arteriography. Methods: The first part is the analysis of the risk intensity difference between the traditional risk factors and the risk factors of the ARAS. The second part is the relationship between the ARAS and the CAD and the peripheral arterial disease (PAD) in the system. the first part 1, the retrieval database comprises: CBM, PubMed, Wanfang database, Web of science, knowledge network database, VIP, EMBASE,2, search time: before October 2013;3, type of study: all case-control studies on the risk factors of ARAS;4, The literature was read and screened one by one by two researchers (Liu Bo and Lu Jianfeng), and the data was extracted according to the observation content;5, the quality evaluation was carried out on the literature according to the nos.6, and the meta-analysis was performed by revman5.2 and stata11.0. The second part 1, the retrieval database: pubmed, webofscience, thecchyranibrry and embase;2, the search time: before 04,2014;3, the type of study: a case-control study on the relationship between aras and cad and pad; and 4, two researchers (liu bo, lu Jianfeng), respectively. The literature was carefully read and screened, and the data was extracted according to the observation contents;5, the quality evaluation was conducted on the literature according to the nos.6, and the meta-analysis was performed using the revman5.2 and the stata11.0 software. Results: In the first part, a total of 17 literatures were used to study the sex of the case group and the control group. The results showed that the odds ratio and the 95% confidence interval were 1.31 (1.21, 1.42);2,15 articles were used to study the hypertension in the case group and the control group, and the results showed that: The ratio ratio and the confidence interval of 95% were 2.42 (2.18, 2.67);3,11 articles were used to study the dyslipidemia in the case group and the control group, and the results showed that the ratio ratio and the 95% confidence interval were 1.55 (1.18, 2.05); and 4,16 articles discussed the diabetes in the case group and the control group. The results showed that the odds ratio and the 95% confidence interval were 1.44 (1.31, 1.58);5,5 of the total 5 articles discussed the systolic blood pressure (sbp) in the blood pressure in the case group and the control group, and included 4553 patients. The results showed that the standard mean difference and the 95% confidence interval were 11.08 (5.01, 17.16); and 6, Diastolic blood pressure (dbp) in the blood pressure in the case group and the control group was discussed in a total of 5 literatures. The results showed that the standard mean difference and the 95% confidence interval were 1.46 (-3.09, 6.10). In the second part, a total of 9 cases of cad in the case group and the control group were discussed and included in the 8237 patients. The results showed that the odds ratio and the 95% confidence interval were 0.70 (0.59, 0.82);2,9 articles discussed the 2 lesions of CAD in the case group and the control group, and included 8237 patients. The results showed that the odds ratio and the confidence interval of 95% were 1.28 (1.10, 1.48), and 3 cases of CAD in the case group and the control group were investigated by 9 articles. The results showed that the ratio ratio and the 95% confidence interval were 2.09 (1.69, 2.59); and 4. A total of 7 literatures were used to study the LMCA lesions of CAD in the case group and the control group. The results showed that the odds ratio and the 95% confidence interval were 1.82 (1.40, 2.36);5,12 articles were used to discuss the PAD in the case group and the control group and included the 11639 patients. The results showed that: The odds ratio and the 95% confidence interval are 3.68 (2.21, 6.10). Conclusion: The first part of women, hypertension, dyslipidemia, diabetes, SBP are the risk factors of ARAS, and the relationship between DBP and ARAS can not be considered. In the second part of CAD,2 lesions,3 lesions, LMCA lesions and PAD were associated with ARAS, and one lesion in CAD was not associated with ARAS.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R692.16
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相關(guān)期刊論文 前3條
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