阿托伐他汀对冠脉介入术后肾功能的影响

摘要

Objective To observe the influences of atorvastatin in different doses on kidney function after coronary angiography ( CAG) or percutaneous coronary intervention ( PCI) , and analyze the mechanism. Methods The patients ( n=120 ) accepted CAG or PCI because of acute coronary syndrome ( ACS ) were selected and randomly divided into group treated with routine dose atorvastatin ( routine group, 20mg/d, n=60) and group with high-dose atorvastatin ( high-dose group,preoperation 40mg/d X 3d, postoperation 20mg/d, n=60) , The level of fractalkine ( FKN ) was detected before and 24 hours after the operation. The levels of serum creatinine ( Scr) , glomenilar filtration rate ( GFR ) and cystatin were detected before the operation and 3 days and 7 days after the operation, and at the same time the correlation between FKN and the above mentioned indexes was analyzed. Results The level of FKN was lower in high-dose group than that in routine group 24 hour after the operation ( P<0.05 ) . The levels of Scr and cystatin were lower and GFR level was higher in high-dose group than those in routine group 3 days after the operation (P<0.05 ) . The incidence of contrast induced nephropathy ( GIN ) had statistical difference between two groups ( 6.67% vs. 16.67%, P<0.05 ) . The results of correlation analysis showed that FKN level was correlated to the levels of Scr and cystatin, and negatively related to GFR level ( P<0.05 ) . Conclusion The intensive treatment of atorvastatin can prevent GIN and the mechanism may be related to FKN.%目的 观察不同剂量阿托伐他汀对冠脉造影术或经皮冠状动脉介入术(PCI)术后肾功能的影响,并对其可能机制进行分析.方法 纳入我院因急性冠脉综合征(ACS)接受冠脉造影术或PCI术的患者120例,随机分为阿托伐他汀常规剂量治疗组(常规组,20mg/d,n=60)和阿托伐他汀高剂量治疗组(高剂量组,术前40mg/d×3d,术后20mg/d,n=60).术前、术后24h检测血清不规则趋化因子(FKN)的水平,术前、术后3天和术后7天检测血肌酐(Scr)、评估肾小球滤过率(eGFR)、血胱抑素(Cys)等,同时分析FKN与上述肾功能指标的相关性.结果 术后24h高剂量治疗组FKN浓度低于常规剂量治疗组(P＜0.05);术后3天高剂量组患者Scr、Cys低于常规组,而eGFR则高于常规组,存在统计学差异(P＜0.05).两组的对比剂肾病(contrast induced nephropathy,CIN)发病率存在统计学差异(6.67%vs.16.67%,P＜0.05).相关性分析结果 显示FKN浓度与患者Scr、Cys水平呈正相关,与eGFR呈负相关(P＜0.05).结论 术前强化阿托伐他汀治疗可预防CIN,其机理可能与FKN有关.