前列地尔预防冠状动脉介入术后高危人群CIN的效果

摘要

目的: 观察前列地尔注射液对经皮冠状动脉介入(PCI)术后高危人群对比剂肾病(CIN)的影响.方法:选择PCI术后的CIN高危(CIN危险积分≥16分)患者263 例.根据随机数字表法,患者被随机分为常规治疗组121例(接受常规水化治疗)和前列地尔组(142例,在常规治疗组基础上加用前列地尔注射液).于PCI术前、术后48 h、72 h分别测定比较两组患者血清肌酐(SCr)、肾小球滤过率(GFR)、胱抑素C(CysC)、β痕迹蛋白(β-TP)水平,并比较两组CIN发生率、需血液净化治疗比例及死亡率.结果:与术前比较,两组术后48h、72h SCr均显著升高,GFR均显著降低(P均<0.01);与常规治疗组比较,前列地尔组术后48h、72h的SCr[72h: (190.04±28.92) μmol/L比(141.10±21.18) μmol/L] 显著降低,GFR水平[72h: (26.0±4.4) ml/min比(36.4±4.9) ml/min]显著升高;CysC[72h: (1.75±0.74) mg/L比(1.47±0.55) mg/L]和β-TP水平[72h: (1.53±0.50) mg/L比(1.22±0.38) mg/L]显著降低(P<0.05或<0.01);前列地尔组CIN发生率(30.6%比18.3%)、需血液净化治疗比例(10.7%比3.5%)显著降低,P分别=0.001, 0.045.两组死亡率无显著差异(P=0.728).结论:前列地尔注射液可明显改善经皮冠状动脉介入术后高危CIN患者肾功能、降低CIN的发生率及需血液净化治疗率,值得临床推广.%Objective:To observe influence of alprostadil injection on contrast-induced nephropathy (CIN) in high risk patients after percutaneous coronary intervention (PCI).Methods: A total of 263 CIN high risk (CIN risk score ≥16 scores) patients were selected.According to random number table, patients were randomly divided into routine treatment group (n=121, received routine hydration therapy) and alprostadil group (n=142, received additional alprostadil injection based on routine treatment group).Serum creatinine (SCr), glomerular filtration rate(GFR), cystatin C (CysC) and β trace protein (β-TP) level before, 48h and 72h after PCI were measured and compared, and incidence rate of CIN, percentage of blood purification therapy and mortality were compared between two groups.Results: Compared with before PCI, there was significant rise in SCr level and significant reduction in GFR in both groups on 48h and 72h after PCI (P<0.01 all);Compared with routine treatment group, there were significant reductions in levels of SCr [72h: (190.04±28.92) μmol/L vs.(141.10±21.18) μmol/L], and significant rise in GFR [72h: (26.0±4.4) ml/min vs.(36.4±4.9) ml/min], and levels of CysC[72h: (1.75±0.74) mg/L vs.(1.47±0.55) mg/L] and β-TP [72h: (1.53±0.50) mg/L vs.(1.22±0.38) mg/L] significantly decreased in alprostadil group on 48h and 72h after PCI, P<0.05 or <0.01;there were significant reductions in incidence rate of CIN (30.6% vs.18.3%) and percentage of blood purification therapy (10.7% vs.3.5%) in alprostadil group, P=0.001, 0.045 respectively.There was no significant difference in mortality between two groups, P=0.728.Conclusion: Alprostadil injection can significantly improve kidney function, reduce incidence rate of CIN and percentage of blood purification therapy in CIN high risk patients after PCI, which is worth extending.