不同剂量尼可地尔对老年冠心病患者造影剂肾病的预防作用

摘要

目的 探讨不同剂量尼可地尔对老年冠心病患者造影剂肾病(CIN)的预防作用.方法 选取2016年12月～2017年11月在天津市南开医院心血管内科住院行PCI的老年冠心病患者121例,应用随机数字表法分为标准治疗组42例、低剂量组39例(术前2d至术后3d口服尼可地尔5 mg/次,3次/d)和高剂量组40例(术前2d至术后3d口服尼可地尔10 mg/次,3次/d).所有患者术前及术后连续3d检测血清肌酐,计算估算肾小球滤过率(eGFR),术前及术后24 h检测尿肾损伤分子1(KIM-1)、中性粒细胞明胶酶相关性脂蛋白(NGAL),比较3组患者CIN发生率、不良反应发生情况等.结果 与标准治疗组比较,低剂量组和高剂量组术后1、2 d CIN和eGFR≥25％比例明显降低,高剂量组术后1、2d血清肌酐水平明显降低,eGFR水平明显升高(P＜0.05,P＜0.01).与低剂量组比较,高剂量组术后2d血清肌酐水平明显降低,eGFR水平明显升高(P＜0.05).高剂量组术后24 h尿KIM-1和NGAL水平较标准治疗组和低剂量组明显降低[(2.77±0.33)μg/L vs (5.63±0.27)μg/L、(4.82±0.32)μg/L,(41.64±8.42)μg/L vs (66.51±10.72)μg/L、(57.11±9.67)μg/L,P＜0.05].结论 口服不同剂量尼可地尔对行PCI的老年冠心病患者CIN的发生具有保护作用,高剂量尼可地尔治疗可能更有效.%Objective To study the role of different dose nicorandil in prevention of CIN in elderly CHD patients.Methods One hundred and twenty-one elderly CHD patients were divided into standard dose nicorandil treatment group (n=42),5 mg nicorandil treatment group (n=39) and 10 mg nicorandil treatment group (n=40).Their Scr levels,and eGFR were measured for 3 days before and after PCI.The urine KIM-1 and NGAL levels were measured before and 24 h after PCI.The incidence of CIN and adverse reactions were compared in 3 groups.Results The incidence of (IN and the eGFR ≥25％ were significantly lower,the serum Scr level was significantly lower while the eGFR was significantly higher in 5 mg and 10 mg nicorandil treatment groups than in standard dose nicorandil treatment group on days 1 and 2 after PCI (P＜0.05,P＜0.01).The serum Scr level was significantly lower while the eGFR was significantly higher in 10 mg nicorandil treatment group than in 5 mg nicorandil treatment group on day 2 after PCI (P＜0.05).The urine KIM-1 and NGAL level were significantly lower in 10 mg nicorandil treatment group than in standard dose nicorandil treatment group and 5 mg nicorandil treatment group at 24 h after PCI (2.77±0.33 μg/L vs 5.63±0.27 μg/L,4.82±0.32 μg/L,P＜0.05;41.64±8.42 μg/L vs 66.51±10.72 μg/L,57.11±9.67 μg/L,P＜0.05).Conclusion Different oral doses of nicorandil play a role in prevention of CIN and 10 mg nicorandil plays a greater role than standard dose nicorandil and 5 mg nicorandil in prevention of CIN in elderly CHD patients undergoing PCI.