前列地尔注射液对行经皮冠状动脉介入治疗的冠心病并糖尿病肾病患者肾功能的影响

摘要

目的：探讨前列地尔注射液对行经皮冠状动脉介入治疗（PCI）的冠心病并糖尿病肾病（DN）患者肾功能的影响。方法选取2014年1月—2015年6月河北医科大学第二医院心内科收治的冠心病并 DN 患者107例，根据治疗方法分为对照组53例和试验组54例。两组患者均行 PCI 及标准水化治疗，对照组患者 PCI 前12 h 静脉注射0.9%氯化钠注射液2 ml，PCI 后静脉注射0.9%氯化钠注射液2 ml/次，1次/ d，连续治疗6 d；试验组患者 PCI 前12 h静脉注射前列地尔注射液20μg，PCI 后静脉注射前列地尔注射液20μg/次，1次/ d，连续治疗6 d。比较两组患者 PCI前及 PCI 后24、48、72 h 估测肾小球滤过率（ eGFR）、胱抑素 C（ CysC），PCI 前及 PCI 后1周尿清蛋白排泄率（UAER）和尿清蛋白/肌酐比值（ ACR）。结果时间与方法在 eGFR、Cys-C上存在交互作用（ P ﹤0.05）；方法在eGFR、Cys-C上主效应显著（P ﹤0.05）；时间在 eGFR、Cys-C上主效应显著（P ﹤0.05）；PCI 后24 h、48 h、72 h，试验组患者 eGFR 高于对照组，CysC 低于对照组（ P ﹤0.05）。PCI 前两组患者 UAER、ACR 比较，差异无统计学意义（P ﹥0.05）。PCI 后1周试验组患者 UAER、ACR 低于对照组（P ﹤0.05）；试验组患者 PCI 后1周 UAER、ACR 低于PCI 前（P ﹤0.05），而对照组患者 PCI 后1周 UAER、ACR 与 PCI 前比较，差异无统计学意义（P ﹥0.05）。结论前列地尔注射液可有效抑制冠心病并 DN 患者 PCI 后Cys-C升高，提高 eGFR，降低尿微量清蛋白含量，对患者肾功能具有一定保护作用。%Objective To investigate the impact of alprostadil injection on renal function of coronary heart disease patients complicated with diabetic nephropathy undergoing PCI. Methods From January 2014 to June 2015,a total of 107 coronary heart disease patients complicated with diabetic nephropathy were selected in the Department of Cardiology,the Second Hospital of Hebei Medical University,and they were divided into control group( n = 53) and experiment group( n = 54) according to therapeutic methods. Patients of the two groups received conventional PCI and standard hydration treatment, meanwhile patients of control group were given intravenous injection of 0. 9% sodium chloride injection(2 ml)before 12 hours of PCI,intravenous injection of 0. 9% sodium chloride injection(2 ml per time,1 time per day) after PCI for 6 days,while patients of experiment group were given intravenous injection of alprostadil injection ( 20 μg) before 12 hours of PCI, intravenous injection of alprostadil injection(20 μg per time,1 time per day)after PCI for 6 days. eGFR and CysC before PCI, after 24 hours,48 hours and 72 hours of PCI,UAER and ACR before PCI and after one week of PCI were compared between the two groups. Results There was interaction between time and method in eGFR and CysC(P ﹤ 0. 05);the main effects of time and method were significant in eGFR and CysC(P ﹤ 0. 05);after 24 hours,48 hours and 72 hours of PCI,eGFR of experiment group was statistically significantly higher than that of control group,respectively,while CysC of experiment group was statistically significantly lower than that of control group,respectively( P ﹤ 0. 05). No statistically significant differences of UAER or ACR was found between the two groups before PCI(P ﹥ 0. 05). After 1 week of PCI,UAER and ACR of experiment group were statistically significantly lower than those of control group(P ﹤ 0. 05);meanwhile UAER and ACR of experiment group were statistically significantly lower than those before PCI(P ﹤ 0. 05),while UAER and ACR of control group were not statistically significantly different compared with those before PCI ( P ﹥ 0. 05 ). Conclusion Alprostadil injection can effectively inhibit the increase of CysC of postoperative coronary heart disease patients complicated with diabetic nephropathy treated by PCI,improve the eGFR and reduce the urine trace albumin levels,has certain protective effect on renal function.