不同剂量辛伐他汀对造影剂肾病患者相关指标的影响

摘要

OBJECTIVE:To explore the effect of different doses of Simvastatin on the related indexes of patients with con-trast-induced nephropathy(CIN). METHODS:168 patients received coronary angiography surgery(CAG)and percutaneous coro-nary stent implantation(PCI)were randomly divided into control group(42 cases),low-dose(42 cases),medium-dose(42 cas-es)and high-dose groups(42 cases),all patients were given Lohexol injection 20 ml. 0.9% Sodium chloride injection was intrave-nously infused at a rate of 2 ml/(kg·h)4 h before radiography until the end,then 0.9% Sodium chloride injection was still intrave-nously infused at a rate of 2 ml/(kg·h)in the end and 48 h after radiography. 48 h before radiography,low-dose group was orally given Simvastatin tablet 20 mg Medium-dose group was orally given Simvastatin tablet 40 mg. high-dose group was orally given Simvastatin tablet 80 mg,once a day. All patients were treated for 4 d. Kidney function indexes(Scr,Ccr,BUN),kidney damage indexes(CysC,NGAL,mAlb),and inflammatory cytokines[(IL)-6,hs-CRP)] before and after radiography,and the incidences of CIN and adverse reactions in all group were observed. RESULTS:After radiography,kidney function indexes,NGAL and mAlb in all group,CysC in control group and low-dose group,CysC after 48 h radiography in medium-dose,high-dose groups were signifi-cantly higher than before,while all the indexes after 24 h radiography in medium-dose,high-dose groups were lower than low-dose group and control group,with statistical significances (P<0.05);after 48 h radiography,medium-dose,high-dose groups were lower than low-dose group,which was lower than control group,with statistical significances(P<0.05). After radiography,the in-flammatory cytokines in all groups were significantly higher than before,while medium-dose,high-dose groups were lower than low-dose group,which was lower than control group,with statistical significances (P<0.05). The incidence of CIN in medi-um-dose,high-dose groups were lower than low-dose group,which was lower than control group,with statistical significances (P<0.05). The incidence of adverse reactions in high-dose group was higher than medium-dose group,followed by low-dose group and control group,with statistical significances (P<0.05). CONCLUSIONS:Both medium-dose and high-dose of Simvas-tatin can effectively reduce the incidence of CIN,improve kidney functions,and reduce kidney damage indexes and inflammatory cytokine levels,while the safety of medium-dose is superior to high-dose.%目的：探讨不同剂量辛伐他汀对造影剂肾病（CIN）患者相关指标的影响。方法：168例行冠脉造影（CAG）术及经皮冠状动脉内支架植入术（PCI）患者随机分为对照组（42例）、低剂量组（42例）、中剂量组（42例）和高剂量组（42例）。对照组患者静脉注射碘海醇注射液20 ml，造影前4 h以2 ml/（kg·h）的速度持续静脉滴注0.9％氯化钠注射液至造影结束，由此至造影后48 h仍以2 ml/（kg·h）的速度持续静脉滴注0.9％氯化钠注射液。造影前48 h低剂量组患者于口服辛伐他汀片20 mg，中剂量组患者口服辛伐他汀服片40 mg，高剂量组患者口服辛伐他汀片80 mg，均为每日1次。各组患者均用药4 d。观察各组患者造影前后肾功能指标[血肌酐（Scr）、内生肌酐清除率（Ccr）、尿素氮（BUN）]、肾损伤指标[半胱氨酸蛋白酶抑制剂C（CysC）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、尿微量白蛋白（mAlb）]、炎症因子[白细胞介素（IL）-6、超敏C反应蛋白（hs-CRP）]，CIN发生率及不良反应发生情况。结果：造影后，各组患者肾功能指标、各组患者NGAL、mAlb及对照组、低剂量组患者CysC，中、高剂量组造影后48 h CysC均显著高于同组造影前。造影后24 h各指标中、高剂量组＜低剂量组及对照组，差异均有统计学意义（P＜0.05）。造影后48 h中、高剂量组各指标＜低剂量组＜对照组，差异均有统计学意义（P＜0.05）。造影后，各组患者炎症因子水平均显著高于同组造影前，但中、高剂量组＜低剂量组＜对照组，差异均有统计学意义（P＜0.05）。CIN发生率中、高剂量组患者＜低剂量组＜对照组，差异均有统计学意义（P＜0.05）。不良反应发生率高剂量组＞中剂量组＞低剂量组及对照组，差异均有统计学意义（P＜0.05）。结论：中、高剂量辛伐他汀均可有效降低CIN的发生，改善肾功能，降低肾损伤指标及炎症因子水平，但中剂量的安全性优于高剂量。