The Clinical Observation Of Intensive Lipid-lowering In Patients With Renal Atherosclerosis Hypertension

Objective：The hypertension caused by renal artery atherosclerotic is a common reason forsecondary hypertension. The renal atherosclerosis is a part of systemic atherosclerosis. Weaim to observe the affection of intensive lipid-lowering on the progress of renal arterystenosis,the change of inflammatory markers related to atherosclerosis and the protection ofrenal function.Method：This study mainly from inflammatory factor levels to explore application of statintreatment lipid after1years later,including the changes of renal artery stenosis, the changesof the related inflammatory markers of atherosclerosis, and the changes of renal function.The28patients with renal artery stenosis diagnosed by color Doppler ultrasonography wereselected from the patients who were treated in Department of Cardiology、Neurology andNephrology in the second hospital of jilin University from July2011to June2013.Theselected patient are treated by conventional antihypertensive therapy make theirs, bloodpressure up to the standard (<140/90mmHg). For the patients without taboos, we chooseACEI or ARB.And the patients were given statins lipid-lowering (10-60mg/d) treatment for1year. In the1th、3th、6th and12th months,we respectively test blood lipid, creatinine, MMP-2,MMP-9, CRP, ox-LDL; In the1th、6th、12th months，liver function is tested。The colorDoppler ultrasonography is arranged in the12th month.We adjust the dose of lipitoraccording to the level of LDL–C until the level of LDL-C reaches2.6mmol/L or thedosage of lipitor reaches60mg/day (not the maximum dose of the drug instructions). Wereexamine the liver function after a month if the dose is changed.we need further observationif the transaminase have slightly elevated.We reduce the dose of lipitor When thetransaminase increases3times. The patients who can not tolerant the side effects along withthe increased dose need a decrease of the dose to the original level.If thepatients,transaminases keep3times higher after their dose of lipitor has been reduced to10mg/d, they need to stop Lipitor and protect liver instead.We use the methods ofenzyme-linked immunosorbent (ELISA) to detect the level of MMP-2、MMP-9、CRP and ox–LDL. Statistical methods is used to analysis the data.Result：1. The levels of LDL and OX-LDL of the28patients who have used atorvastatin(lipitor) for12months have decreased;19patients have completed the renal color Dopplerultrasonography after12months.The level of LDL have a positive correlation with the levelof peak systolic flow velocity (PSV) and renal-aortic (RAR)(R values were0.288,0.061; Pvalues were0.023,0.048) with Pearson correlation analysis. The level of OX-LDL have apositive correlation with the leval of PSV and RAR(R values were0.250,0.121; P valueswere0.0320.026)with Spearman rank correlation analysis.The blood flow velocity of renalartery have decreased with the extension of intensive lipid-lowering.2.(1).According to the renal artery blood flow parameters of PSV and RAR diagnosedby the renal color Doppler ultrasonography,the selected patients have divided into threegroups:The first group: the degree of stenosis <50%;The second group:50%≤the degreeof stenosis＜60%; The third group: the degree of stenosis≥60%.The serum levels ofMMP-2、MMP-9、CRP of three groups show no statistical difference（P>0.05）；(2)According to result of coronary angiography，we divide the patients into CHD group and nonCHD group.The serum levels of MMP-2、MMP-9、CRP of two groups of patients show nostatistical difference（P>0.05）.3.According to the results of creatinine,We divide the28patients into two groups: thegroup with normal renal function and the group with abnormal renal function.The level ofeGFR of the two groups have decreased as the extension of time in0th、1th、3th、6th、12thmonths and the result of eGFR in0th、1th、3th、6th、12th months shows a statisticallydifference（P<0.05）.4.The level of biochemical indicators (cholesterol, triglycerides) and inflammatoryfactor (MMP2、MMP-9、CRP、OX-LDL) of28patients have decreased as the extensionof time and show a statistical difference (P <0.05) at0th、1th、3th、6th、12th months.5.The level of alanine aminotransferase (ALT)、aspertate aminotransferase (AST)、creatine kinase (CK)、 creatine kinase isoenzyme (CK-MB) show no statisticaldifference(P>0.05) at0th、1th、3th、6th、12th months.Conclusions：Intensive lipid-lowering therapy with statins is safe not only could control the degree of renal artery atherosclerotic stenosis,but also could protect the function of the kidney.