强化阿托伐他汀治疗对PCI术后肾功能的影响

摘要

Objective To investigate whether intensive atorvastatin treatment in patients after percutaneous coro-nary intervention ( PCI) could decrease the effect of contrast medium on kidney function and the incidence of con-trast-induced acute kidney injury( CI-AKI) . Methods A total of 128 patients with PCI were randomly divided into two groups:the enhanced treatment group (n=64) and the control group(n=64). The enhanced treatment group received 80 mg atorvastatin at 12~24 h before PCI and 24,48 h after PCI. The control group was given 20 mg ator-vastatin respectively before and after PCI. The primary end point was the incidence of CI-AKI. Serum creatinine (Scr), cystatin C, glomerular filtration rate(eGFR), urinary albumin and urinary β-2 microglobulin levels were observed at 24 h before PCI and 24, 48, 72 h after PCI. Results In the enhanced treatment group 3. 1 % (n=2) of patients developed CI-AKI versus 4. 7 % (n=3) in the control group, without statistical difference (P=1.00). There was no significant difference between two groups in postoperative Scr, cystatin C, eGFR, urinary al-bumin, urinary β-2 microglobulin and creatine kinase(CK). Three days after the operation, alanine aminotrans-ferase ( ALT) elevated in two groups, and aspartate aminotransferase ( AST) increased in the enhanced treatment group (P<0. 05), but they were all in the normal range. Conclusion There has been no significant difference in decreasing the incidence of CI-AKI and the damage of contrast medium on renal function between the enhanced treatment group and the control group before PCI.%目的探讨强化剂量的阿托伐他汀能否减轻经皮冠脉介入术( PCI)对患者肾功能的影响及减少对比剂致急性肾损伤( CI-AKI)的发生率。方法将128例接受PCI治疗的患者随机分为2组：强化组(n=64)和对照组(n=64)。强化组术前12~24 h、术后第1天及第2天均口服80 mg阿托伐他汀,对照组术前及术后口服20 mg阿托伐他汀。主要终点事件是CI-AKI的发生率,并观察患者术前24 h和术后24、48、72 h的血清肌酐( Scr)、胱抑素C、肾小球滤过率( eG-FR)、尿白蛋白、尿β-2微球蛋白水平。结果强化组3.1%(n=2)的患者发生CI-AKI,对照组为4.7%(n=3),两组间差异无统计学意义( P=1.00)；术后两组间Scr、胱抑素C、eGFR、尿白蛋白、尿β-2微球蛋白和肌酸激酶( CK)差异均无统计学意义。术后3 d两组谷丙转氨酶( ALT)升高,强化组谷草转氨酶(AST)亦升高(P<0.05),但均在正常参考值范围内。结论 PCI术前强化阿托伐他汀治疗与常规剂量比较在减轻肾功能损伤和降低CI-AKI发生率方面差异无统计学意义。