不同剂量阿托伐他汀对糖尿病患者应用对比剂后肾功能的影响

摘要

Objective To observe the effect of different doses of atorvastatin on renal impairment caused by contrast agent in patients with diabetes mellitus (DM) who underwent visualization.Methods A total of 60 DM patients undergoing visualization were randomly divided into 20 mg atorvastatin group and 80 mg atorvastatin group ; in each group,patients took 20 mg or 80 mg atorvastatin daily 3 days before visualization.The levels of high-sensitivity CRP (hs-CRP),cystain C (CysC),urinary retinal binding protein (RBP),serum creatinine(Scr) and blood urea nitrogen (BUN) were detected before,1 and 2 days after visualization.The creatinine clearance rate (Ccr) and glomerular filtration rate(GFR) were calculated.Results CysC,GFR,urine RBP,hs-CRP in 20 mg statin group were (0.78 ± 0.35)mg/L,(104 ± 16)ml/min,(0.47 ± 0.15)mg/L and(3.7 ± 1.0)mg/L before operation ;on postoperative 1 d,they were (1.00 ± 0.46) mg/L,(85 ± 8) ml/min,(0.80 ± 0.19) mg/L,(7.8 ± 1.1)mg/L,respectively; on postoperative 2 d,they were(0.94 ±0.14) mg/L,(93 ± 18) ml/min,(0.71 ±0.23) mg/L,(9.9 ± 1.2) mg/L,respectively.CysC,GFR,urine RBP,hs-CRP in 80 mg statin group were (0.79 ± 0.41) mg/L,(102 ± 7) ml/min,(0.43 ± 0.23) mg/L,(3.6 ± 1.7) mg/L,before operation ; on postoperative 1 d,they were(0.88 ±0.41) mg/L,(94 ± 16) ml/min,(0.54 ±0.20) mg/L,(5.7 ± 1.7) mg/L,respectively; on post-operative 2 d,they were (0.82 ± 0.12) mg/L,(100 ± 16) ml/min,(0.47 ± 0.19) mg/L,(6.8 ± 1.6) mg/L,respectively.Compared with those in 20 mg statin group,serum CysC,hs-CRP,urine RBP levels in 80 mg statin group were significantly lower after operation(P ＜ 0.05).Compared with the preoperative levels in two groups,CysC,hs-CRP and uric RBP were significantly elevated on postoperative 1 d and GFR was significantly decreased (P ＜ 0.05).CIN did not occur in two groups; urea nitrogen,Scr,Ccr had no differences before and after angiography (P ＞ 0.05).Conclusion Pretreatment with high dose of atorvastatin 3 days for DM patients before visualization can effectively alleviate the renal impairment caused by contrast agent.%目的 观察阿托伐他汀对糖尿病患者应用对比剂后肾功能的影响.方法 将60例拟行造影术的糖尿病患者完全随机分为20 mg阿托伐他汀组和80 mg阿托伐他汀组,各30例,分别于术前3d每晚服用阿托伐他汀20、80 mg.术前和术后第1、2天检测血清胱抑素C(CysC)、肾小球滤过率(GFR)、尿视黄醇结合蛋白(RBP)、高敏C反应蛋白(hs-CRP)、尿素氮和血清肌酐(Scr)并计算肌酐清除率(Ccr).结果 20 mg阿托伐他汀组术前CysC、GFR、尿RBP、hs-CRP分别为(0.78 ±0.35) mg/L、(104±16) ml/min、(0.47±0.15) mg/L、(3.7±1.0)mg/L,术后第1天分别为(1.00±0.46) mg/L、(85±8)ml/min、(0.80 ±0.19) mg/L、(7.8 ±1.1)mg/L,术后第2天分别为(0.94±0.14) mg/L、(93±18) ml/min、(0.71±0.23) mg/L、(9.9±1.2) mg/L.80 mg阿托伐他汀组术前CysC、GFR、尿RBP、hs-CRP分别为(0.79±0.41)mg/L、(102±7)ml/min、(0.43 ±0.23) mg/L、(3.6 ± 1.7)mg/L,术后第1天分别为(0.88 ±0.41) mg/L、(94±16) ml/min、(0.54±0.20) mg/L、(5.7±1.7) mg/L,术后第2天分别为(0.82±0.12) mg/L、(100±16) ml/min、(0.47±0.19) mg/L、(6.8±1.6) mg/L.与20 mg阿托伐他汀组比较,术后第1、2天,80 mg阿托伐他汀组血清CysC、hs-CRP、尿RBP水平明显降低(P＜0.05),GFR明显升高(P＜0.05).与术前比较,术后第1天2组CysC、hs-CRP、尿RBP均明显升高,GFR明显下降(P＜0.05);与术后第1天比较,术后第2天2组CysC、尿RBP均明显下降,GFR明显升高(P＜0.05).2组均未见发生造影剂肾病,造影前后尿素氮、Scr、Ccr差异无统计学意义(P＞0.05).结论 糖尿病患者造影前应用大剂量阿托伐他汀能改善造影剂引起肾功能损害.