阿托伐他汀联合水化预防冠状动脉介入术后造影剂肾病的临床研究

摘要

目的:比较60 mg/d与40 mg/d阿托伐他汀分别联合水化预防急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后造影剂肾病(CIN)的效果.方法:选取172例AMI患者随机分为高剂量组(88例)与低剂量组(84例),在常规PCI治疗基础上,高剂量组患者入院后至术后72 h口服阿托伐他汀60 mg/d,低剂量组口服阿托伐他汀40 mg/d,同时2组患者围术期均予静脉滴注生理盐水水化治疗,记录2组手术指标、治疗前、后生物学标志物及肾功能变化,比较2组CIN及临床不良事件发生率.结果:2组患者造影剂用量、接触时间、水化量及冠状动脉旋磨比例、平均每例患者支架植入数量差异均无统计学意义(均P＞0.05).高剂量组术后3d外周血血清N-末端脑钠肽前体(NT-proBNP)、超敏C-反应蛋白(hs-CRP)、金属基质蛋白酶(MMP-9)较术前下降数值均显著高于低剂量组[(0.5±0.2) pg/mL vs(0.4±0.2) pg/mL,(7.8±2.4)mg/Lvs (6.3±1.9) mg/L,(27.5 ±9.5)μg/Lvs (23.7±7.7)μg/L,均(P＜0.05)].高剂量组术后3d血肌肝(Scr)、尿素氮(BUN)较术前升高数值及肾小球滤过率(eGFR)下降数值均显著低于低剂量组[(11.9±3.5) μmol/Lvs(19.6±5.8) μmol/L,(1.5±0.5)mmol/L vs(2.4±0.7) mmol/L,(5.0±2.2) mL/(min·1.73m2)vs(9.2±3.8)mL/(min·1.73 m2),均P＜0.05].高剂量组术后CIN发生率、肾脏透析治疗比例均显著低于低剂量组[6.8％vs16.7％,1.1％vs8.3％,均P＜0.05].结论:PCI围手术期口服阿托伐他汀联合常规水化能预防CIN的发生,60 mg/d的预防效果优于40 mg/d.%Objective:To compare the efficacy of hydration combined with 60 mg/day or 40 mg/day atorvastatin on prevention of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Methods:172 AMI patients were randomly divided into high dose group (88 cases) and low dose group (84 cases).Based on the conventional treatment of PCI,the patients in high dose group after admission to 72 h after PCI were given 60 mg/day atorvastatin orally,and those in low dose group given 40 mg/day atorvastatin orally,at the same time two groups in the perioperative period were given intravenous saline water treatment.The operation associated indexes,variations on biological markers and renal function before and after operation were recorded,and the incidence of CIN and clinical adverse events were noted and compared between the two groups.Results:There was no significant difference in contrast agent dosage,contact time,hydration volume and coronary atherectomy ratio,and mean number of stent implantation per patient (P ＞ 0.05).The decreased values of NT-proBNP,Hs-CRP and MMP-9 in the high dose group at 72 h after PCI as compared with the preoperative values were significantly higher than those in the low dose group [(0.5 ± 0.2) pg/mL vs (0.4±0.2) pg/mL,(7.8±2.4) mg/Lvs (6.3±1.9) mg/L and (27.5 ±9.5) μg/Lvs (23.7±7.7) μg/L] (allP＜0.05).The increased values of Scr and BUN,and the decreased values of eGFR in the high dose group at 72 h after PCI as compared with the preoperative values were significantly lower than those in the low dose group [(11.9 ± 3.5) μmol/L vs (19.6 ± 5.8) μmol/L,(1.5 ±0.5) mmol/Lvs (2.4±0.7) mmol/L,and (5.0±2.2) mL/(min · 1.73 m2) vs (9.2±3.8)mL/(min · 1.73m2)] (P＜0.05).The incidence rate of CIN and the ratio of patients accepting renal dialysis in the high dose group were significantly lower than those in the low dose group [6.8％ vs 16.7％,1.1％ vs 8.3％] (P＜0.05).Conclusion:Atorvastatin combined with conventional hydration during PCI can prevent the occurrence of CIN,and the preventive effect of 60 mg/day atorvastain is better than 40 mg/day.