目的 研究曲美他嗪在肾功能不全患者冠脉介入术后,预防造影剂肾病(CIN)的疗效.方法 纳入160例行冠脉介入术的肾功能不全患者,采用随机数字表法分为两组:对照组和曲美他嗪组,均予水化治疗.曲美他嗪组患者术前48 h和术后7 d予曲美他嗪片20 mg/次,每天3次.监测术前1 d和术后3 d血清肌酐(SCr)和胱抑素C(CysC)水平,并随访1年.结果 (1)术后24 h、48 h:对照组SCr和CysC较基线水平显著升高(P<0.05);曲美他嗪组SCr和CysC与基线水平相比,差异无统计学意义(P>0.05);曲美他嗪组SCr和CysC水平显著低于对照组(P<0.05).(2)曲美他嗪组CIN发生率显著低于对照组(P=0.034).(3)Kaplan-Meier分析发现,随访1年曲美他嗪组不良事件发生率显著低于对照组(P=0.003).结论 曲美他嗪在行冠脉介入术的肾功能不全患者中,可有效预防CIN发生.%Objective This study was to investigate the role of trimetazidine in the prevention of contrast-induced nephropathy (CIN) in renal dysfunction patients undergoing coronary angiography. Methods A total of 151 patients with renal dysfunction who underwent coronary angiography were enrolled in our study and randomly divided into control group (n=77) and trimetazidine group (n=74). Standard hydration was administered in all the patients. In trimetazidine group, patients were administered trimetazidine orally for 48 hours before and 7 days after coronary angiography. Adverse events were observed in 12 months. Results (1) For 24 h and 48 h after the procedure:levels of SCr and CysC in the control group were significantly increased compared with baseline levels; levels of SCr and CysC in trimetazidine group were not increased, compared with baseline levels;levels of SCr and CysC were lower in trimetazidine group than the control group. (2)The incidence of CIN was reduced in trimetazidine group compared with control group (22.1%vs 9.5%,P=0.034). (3) Kaplan-Meier analysis showed that the incidence of adverse events in trimetazidine group was lower compared with the control group (P = 0.003). Conclusions Trimetazidine in combination with standard hydration is more effective than isotonic saline alone in protecting renal function in patients with renal dysfunction who undergo coronary angiography.
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