天津医药

• 心血管疾病研究 • 上一篇    下一篇

阿托伐他汀联合普罗布考改善对比剂急性肾损伤的临床观察

王一然1,李曦铭2,张迎怡3,李作成4,肖建勇1,丛洪良2   

  1. 1. 天津市胸科医院
    2. 天津胸科医院
    3. 胸科医院心内科
    4. 天津市胸科医院心内科
  • 收稿日期:2010-08-25 修回日期:2010-11-10 出版日期:2011-01-15 发布日期:2011-01-15
  • 通讯作者: 王一然

The Clinical Observation of Atorvastatin Combining Probucol to Improve Contrast-induced Acute Kidney Injury

  • Received:2010-08-25 Revised:2010-11-10 Published:2011-01-15 Online:2011-01-15
  • Contact: Yi-ran WANG

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摘要： 摘要 目的： 观察术前联用不同剂量的阿托伐他汀与普罗布考对对比剂急性肾损伤（contrast induced acute kidney injury CIAKI）的改善作用。方法：98例住院接受择期冠状动脉造影（coronary angiography CAG）或经皮冠状动脉支架植入术（percutaneous coronary intervention PCI）的冠心病患者，按照完全随机化原则分为标准剂量治疗组：阿托伐他汀每晚顿服20mg及普罗布考250mg,3次/天，术前无强化；强化联合剂量治疗组阿托伐他汀每晚顿服40mg 及普罗布考250mg,3次/天，术前2小时顿服阿托伐他汀40mg普罗布考0.5g；强化剂量治疗组阿托伐他汀每晚顿服40mg，术前2小时顿服阿托伐他汀40mg。所有患者均于术前，术后24小时抽取静脉血，检测尿素氮（blood urea nitrogen BUN），血清肌酐(serum creatinine Scr )，肾素全项（肾素活性 血管紧张素II 醛固酮），并采用MDRD方法估算肾小球率过滤（effective glomerular filtration rate eGFR）。结果：（1）标准剂量治疗组术后Scr较术前升高（P=0.044），e GFR下降（P=0.006）; 强化联合剂量治疗组（P＜0.001）及强化剂量治疗组（P=0.029）术后BUN较术前下降，Scr及e GFR无统计学意义。（2）组间比较，强化联合剂量治疗组Scr基线与介入术后24小时的差值△Scr（P=0.02），及△AngII（P=0.04）增高，△e GFR（P=0.015）减低。（3）对于肾功能轻中度损伤患者，强化联合剂量治疗组的△ Scr（P=0.025）和△AngII（P=0.031）增高, △eGFR（P=0.025）降低。 结论：术前联用阿托伐他汀40mg和普罗布考250mg,3次/天，以及单用阿托伐他汀40mg，均可改善CIAKI，但作用以强化联合治疗尤为显著。对于肾功能轻中度损伤患者，强化联合治疗也具有明显的改善作用。

关键词: 阿托伐他汀, 普罗布考, 对比剂急性肾损伤, 肾素-血管紧张素-醛固酮系统

Abstract: Abstract Objective To observe the improvement on contrast induced acute kidney injury (CIAKI) before coronary angiography with different doses of atorvastatin combined with probucol. Methods 98 cases admitted for coronary angiography (CAG) or percutaneous coronary stent implantation(PCI) were randomly divided into three groups：Standard treatment group: atorvastatin 20mg qn and Probucol 0.25g/tid, no enhancement before angiography; Strengthen and combined treatment group: atorvastatin 40mg qn and Probucol 0.25g/tid, atorvastatin 40mg and Probucol 0.5g 2 hours were administered before the angiography; Intensive therapy group: atorvastatin 40mg qn, atorvastatin 40mg 2 hours were administered before the angiography. All patients were then evaluated 24 hours before and after the angiography procedure, and their blood urea nitrogen (BUN), serum creatinine (Scr),renin All items (renin ,AngII and aldosterone), and estimated glomerular filtration rate (eGFR) by MDRD method were tested. Results 1) The Scr of Standard treatment group was higher postoperatively than the preoperative value (P = 0.044), e GFR decreased significantly (P = 0.006); The BUN of Strengthen and combined treatment group (P <0.001) and Intensive therapy group (P = 0.029) were remarkably decreased postoperatively. There was no significant difference in Scr and e GFR. (2) The value of △ Scr (P = 0.02)and△ AngII (P = 0.04) in Strengthen and combined treatment group was higher , △ e GFR (P = 0.015) was reduced.（3）For the patients of mild to moderate renal function , The value of△ Scr (P = 0.025) and △ AngII (P = 0.031) in Strengthen and combined treatment group significantly increased , △ eGFR (P = 0.025) was reduced .Conclusion The combination of atorvastatin 40mg and Probucol 0.25 tid or one with atorvastatin 40mg before angiography could improve the CIAKI, however, the role of Strengthen and combined treatment group improved significantly. For the patients of mild to moderate renal function, Strengthen and combined treatment group could improve significantly.

Key words: Atorvastatin, Probucol, contrast induced acute kidney injury, Renin - angiotensin - aldosterone system.