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强化阿托伐他汀对经皮冠状动脉介入治疗术后对比剂肾病预防作用*

李英   

  1. 天津医科大学研究生院
  • 收稿日期:2011-11-08 修回日期:2012-01-17 出版日期:2012-10-15 发布日期:2012-10-15
  • 通讯作者: 李英

The preventive effects of intensive doses of atorvastatin on contrast induced nephropathy in patients undergoing percutaneous coronary intervention

  • Received:2011-11-08 Revised:2012-01-17 Published:2012-10-15 Online:2012-10-15

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摘要： 目的： 探讨术前强化他汀治疗，对经皮冠状动脉介入治疗（PCI）术后对比剂肾病（CIN）是否具有预防作用。方法： 前瞻性入选2011年5月至10月行择期PCI术患者共242例，随机将其分为他汀强化治疗组和他汀常规治疗组，其中强化治疗组122例、常规治疗组120例。2组患者均在水化基础上于PCI术前2d，每日分别给予阿托伐他汀40mgQD和20mgQD口服。观察2组患者PCI术前及术后72h血尿素氮（BUN）、肌酐（Scr）、肌酐清除率（Ccr）、肾小球滤过率（eGFR）、β2微球蛋白（β2-MG）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、谷丙转氨酶（ALT）的变化。结果：（1）强化治疗组122例患者中有3例发生CIN，CIN发病率为2.5%；常规治疗组120例患者中有7例发生CIN，发病率为5.8%，2组患者CIN发病率差异未见统计学意义（χ2=1.74，p>0.05）。（2）强化治疗组与常规治疗组，PCI术前血BUN、Scr、Ccr、eGFR、β2-MG、CRP、IL-6、TNF-α、ALT，差异无统计学意义（P>0.05）。2组患者术后72h血β2-MG 、CRP、IL-6、TNF-α均较术前增高。PCI术后72h，强化治疗组β2-MG、CRP、IL-6、TNF-α水平，低于常规治疗组；Ccr、eGFR，高于常规治疗组，差异均有统计学意义（P<0.05）。结论：尽管2组患者CIN发病率差异未见统计学意义，但生化指标差异的统计学意义，显示PCI术前强化他汀治疗的肾保护趋势，其机制可能与其抗炎症作用有关。因此，PCI术前强化阿托伐他汀治疗，对PCI术后CIN的发生具有一定的预防作用。

关键词: 阿托伐他汀, 对比剂肾病, 预防, 冠心病, 经皮冠状动脉介入治疗

Abstract: Objective: To investigate the preventive effects of intensive doses of atorvastatin on contrast induced nephropathy（CIN） in patients undergoing percutaneous coronary intervention（PCI）.Methods: Two hundred and forty-two patients who are about to undergo PCI in Tianjin Chest Hospital are randomly divided into eithe conventional treatment group（n=120） or intensive treatment group（n=122）.Patients in the two groups are given atorvastatin 20mg and 40mg respectively dialy two days before PCI. The levels of blood urea nitrogen（BUN）, serum creatinine（Scr）, creatinine clearance rate （Ccr）, estimated glomerular filtration rate （eGFR）, interleukin-6（IL-6）, β2-microglobulin（β2-MG）, C-reactive protein（CRP）, tumor necrosis factor-α（TNF-α）, alanine aminotransferase（ALT）were measured at admission and 72h after the procedure. Result:（1）In the intensive treatment group, only 3 patients present with CIN，the incidence of CIN was 2.5%;In the conventional treatment group, CIN occur in seven patients, the incidence of CIN was 5.8%（χ2=1.74，p>0.05）.（2）There was no statistically difference in the levels of BUN、Scr、IL-6 、β2-MG、CRP、TNF-α at admission（P>0.05）. 72h after the procedure, the levels of IL-6, β2-MG, CRP, TNF-α were lower in intensive treatment group than the conventional treatment group, and the levels of Ccr and eGFR were higher in intensive treatment group. Conclusion: Although there was no statistically difference in the incidence of CIN between the 2 groups , the statistically differences in biochemical parameters indicate the tendency of renal protection of intensive treatment before PCI. The protection mechanism may be due to the anti-inflammatory effects. Therefore, the adminstintion of intensive atrovtatin before PCI can be beneficial in the prevention of CIN.

Key words: atorvastatin, contrast induced nephropathy, prevent, coronary heart disease, percutaneous coronary intervention