前列腺素E1对行冠状动脉造影或介入治疗老年人肾脏的保护作用

摘要

Objective To investigate the nephroprotective effects of prostaglandin E1 (PGE1) in the elderly undergoing coronary angiography or intervention. Methods 161 patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) were randomly assigned to PGE1 group (n=87 cases) and control group (n=74 cases).10 μg lipo-PGE1 added to 100 ml normal saline were administered intravenously once daily for 5 days before and 2 days after the operation.The serum levels of creatinine (Scr) and cystatin C (Cys C) were measured on admission and 48 h after the procedure.Results After the procedure,the levels of Scr and Cys C were increased (P＜0.01) and creatinine clearance (Ccr) was decreased (P＜0.05) in control group than in PGE1 group.The incidence of contrast-induced acute kidney injury (CI-AKI) in control group 〔12.2％ (9/74)〕 was higher than in PGE1 group 〔3.4％(3/87)〕 (P＜0.05).The application of P(GE1 decreased CI-AKI,but high basic level of Scr and diabetes mellitus enhanced the incidence of CI-AKI by logistic regression.The serum levels of Cys C had negative correlation with Ccr (r=-0.615,P＜0.01).Conclusions Perioperative application of PGE1 has nephroprotective effects in the elderly undergoing CAG or PCI,and decreases the incidence of CI-AKI.The serum levels of Cys C is one of ideal indexes for auxiliary diagnosis of CI-AKI.%目的 探讨前列腺素E1(PGE1)对行冠状动脉造影(CAG)或经皮冠状动脉介入治疗术(PCI)老年人的肾脏保护作用.方法 拟行CAG或PCI的患者161例,数字抽签随机分为PGE1组(87例)和对照组(74例).PGE1组患者术前5d至术后2d用脂微球PGE110μg加入生理盐水100ml中静脉滴注,1次/d.人院和术后48 h查血肌酐和胱抑素C(Cys C)水平.结果 与PGE1组比较,对照组术后血肌酐水平和血清Cys C水平升高(均P＜0.01)；而肌酐清除率(Ccr)降低(P＜0.05).对照组对比剂诱导的急性肾损伤(CI-AKI)发生率高于PGE1组,分别为12.2％(9/74)和3.4％(3/87),差异有统计学意义(P＜0.05).Logistic回归分析结果显示,使用PGE1可降低CI-AKI 发生率；而高基线水平的血肌酐、糖尿病增加CI-AKI发生率.血清Cys C水平与Ccr呈负相关(r=-0.615,P＜0.01).结论 围术期应用P(GE1对行CAG或PCI的老年人具有肾脏保护作用,并能降低CI-AKI的发生率.血清Cys C水平可作为CI-AKI的辅助诊断指标之一.