替格瑞洛对急性冠状动脉综合征患者急诊经皮冠状动脉介入术后造影剂肾病的影响

摘要

Objective To compare the effect of ticagrelor and clopidogrel on contrast induced nephropathy ( CIN) in acute coronary syndrome patients underwent emergency percutaneous coronary intervention (PCI).Methods Clinical data of 221 acute coronary syndrome patients who had received emergency PCI was retrospectively analyzed , 118 cases in the ti-cagrelor group, 103cases in the clopidogrel group .The serum creatinine (SCr), estimate glomerular filtration rate (eGFR) and CIN incidence of before PCI or 72 hours after PCI from patients in both groups were compared .Results The general data and medication of both groups were comparable .The SCr and incidence of CIN after PCI in ticagrelor group were higher than those in clopidogrel group[SCr:(112.0 ±23.2)μmolL/vs .(106.5 ±19.7)μmol /L, t =1.834, P =0.068; CIN:6.8%vs.4.8%,χ2 =0.368, P =0.544], and the eGFR in ticagrelor group was lower than that in the clopidogrel group [(81.4 ± 21.5) ml/min-1· 1.73m-2 vs.(83.2 ±20.3) ml/min-1· 1.73m-2,t =0.637,P =0.525), but the differences were not statistically significant ( P >0.05).Analysis of the two groups of patients with moderate to severe renal insufficiency showed higher SCr(133.3 ±12.1μmol/L vs.126.0 ±12.1μmol/L, t =2.140, P =0.038) and lower eGFR(42.3 ±6.2 ml/min-1 · 1.73m-2 vs.46.7 ±7.5 ml/min-1 · 1.73m-2 , t =2.246, P =0.029) in ticagrelor group than those in clopidogrel group , the difference was statistically significant ( P <0.05).The incidence of CIN was higher in the patients with moderate to se-vere renal insufficiency in ticagrelor group than those in clopidogrel group , however, there was no statistical significance (P >0.05).Conclusion In all patients with ACS who underwent emergency PCI , the general incidence of CIN in ticagrelor group and clopidogrel group had no difference .However ,increased incidence of CIN was observed in patients with moderate to severe renal insufficiency in ticagrelor group .Prophylactic treatments should be helpful to these patients in the perioperative period .%目的：比较替格瑞洛和氯吡格雷对急性冠状动脉综合征患者行急诊经皮冠状动脉介入治疗术（ PCI ）后造影剂肾病（ CIN）的影响。方法回顾性分析2014年1月—2015年12月第二军医大学附属长征医院心内科行急诊CAG和PCI术的急性冠状动脉综合征患者221例的临床资料，其中替格瑞洛组118例，氯吡格雷组103例，统计患者的一般资料， PCI前及术后72 h的血清肌酐水平（SCr）、肾小球滤过率（eGFR）和CIN的发生情况。结果替格瑞洛组患者术后72 h SCr水平高于氯吡格雷组[（112．0±23．2）μmol／L vs．（106．5±19．7）μmol／L， t ＝－1．834， P ＝0．068]，而eGFR 水平低于氯吡格雷组[（81．4±21．5） ml·min －1·1．73m－2 vs．（83．2±20．3）ml· min－1·1．73m－2， t ＝0．637， P ＝0．525]，但差异均无统计学意义（ P ＞0．05）。替格瑞洛组CIN发生率高于氯吡格雷组（6．8％ vs．4．8％），但差异无统计学意义（χ2＝0．368， P ＝0．544）。分析2组中重度肾功能不全患者，结果显示替格瑞洛组术后的SCr 水平高于氯吡格雷组[（133．3±12．1）μmol／L vs．（126．0±12．1）μmol／L， t ＝－2．140， P ＝0．038]，eGFR水平低于氯吡格雷组[（42．3±6．2）ml· min－1·1．73m－2 vs．（46．7±7．5）ml· min－1·1．73m－2， t ＝2．248， P ＝0．029]，差异均有统计学意义（ P ＜0．05）；中重度肾功能不全患者，替格瑞洛组 CIN 发生率高于氯吡格雷组（19．2％ vs．13．0％，χ2＝0．039， P ＝0．843），但差异无统计学意义。结论行急诊PCI的ACS 患者人群中，替格瑞洛组和氯吡格雷组CIN发生率无差异，但在中重度肾功能不全患者中，替格瑞洛相较氯吡格雷CIN发生率有升高趋势，在围术期应尽可能给予预防CIN的治疗措施。