不同剂量阿托伐他汀预防高敏C反应蛋白增高患者经皮冠状动脉介入术后对比剂肾病的效果比较

摘要

Objective To compare the effects of different doses of atorvastatin on the prevention of contrast-induced nephropathy ( CIN) after percutaneous coronary intervention( PCI) in the patients with elevated high-sensitivity C-reactive protein( hs-CRP) . Methods Seventy-eight patients with coronary heart disease who underwent PCI were divided into study group(n=39) and control group(n=39) using the random number table method. The patients in the two groups were treated with atorvastatin at 24 hours before PCI and within 72 hours after operation. The control group was given a conventional dose of oral atorvastatin(20 mg/d),and the study group was given the intensive therapy with a high dose of atorvastatin(40 mg/d). The levels of hs-CRP,serum creatinine(SCr) and blood urea nitrogen(BUN) were compared between the two groups before operation and within 72 hours after operation,and the incidence rates of CIN and adverse cardiovascular events were counted in the two groups. Results The levels of hs-CRP and SCr increased and the level of BUN decreased in both groups after operation(all P<0. 05). After operation,the level of hs-CRP in the study group was lower than that in the control group (P<0. 05),but no significant difference was found in the SCr or BUN level between the two groups(P>0. 05). There was no significant difference in the incidence rate of CIN or adverse cardiovascular events between the two groups(P>0. 05). Conclusion Compared with the conventional dose therapy,the intensive therapy of atorvastatin can significantly reduce the level of hs-CRP after PCI in patients with elevated hs-CRP,but both of them have similar preventive effects on CIN.%目的 比较不同剂量阿托伐他汀预防高敏C反应蛋白(hs-CRP)增高患者经皮冠状动脉介入术(PCI)后对比剂肾病(CIN)的效果.方法 选取行PCI治疗的冠心病患者78例,采用数字表法随机分为研究组和对照组各39例,两组患者均在PCI术前24 h至术后72 h内应用阿托伐他汀治疗,对照组给予常规剂量20 mg/d口服,研究组给予大剂量40 mg/d强化治疗,对比两组患者术前及术后72 h内的hs-CRP、血清肌酐(SCr)、尿素氮(BUN)水平,统计两组患者CIN发生率及不良心血管事件的发生率.结果 术后两组的hs-CRP、SCr水平均增高,BUN水平均降低(均P<0.05);术后研究组的hs-CRP水平低于对照组(P<0.05),但两组的SCr、BUN水平比较,差异无统计学意义(P>0.05).两组CIN及不良心血管事件发生率比较,差异也无统计学意义(P>0.05).结论 与常规剂量治疗相比,强化阿托伐他汀治疗能够更显著地降低hs-CRP增高患者PCI术后的hs-CRP水平,但两者对CIN的预防效果相当.