阿托伐他汀与水化疗法联用预防PCI术后对比剂肾病的研究

目的评价阿托伐他汀与水化疗法联合应用预防经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)的临床效果。方法选择120例冠心病择期接受冠状动脉造影及介入治疗患者,随机分为A、B、C三组,A组接受阿司匹林、硝酸酯类、血管紧张素转换酶抑制剂等常规治疗,B组在常规治疗的基础上加用水化疗法,C组在B组的基础上加用阿托伐他汀40 mg。分别于术前1天、术后1天测定血尿素氮(BUN)、血肌酐(Scr),留取尿标本检测尿微量白蛋白(mALB)、白介素18(IL-18),并计算出肌酐清除率(Ccr)和肾小球滤过率(GFR)。结果术后A、B、C三组中出现对比剂肾病(CIN)的例数分别为7(17.5%)、4(10.0%)、1(2.5%),B、C两组发生率显著低于A组,有统计学差异(P<0.05),其中C组又明显低于B组,有统计学差异(P<0.05);与术前相比,三组患者术后BUN、Scr、mALB以及IL-18均明显升高,有统计学差异(P<0.05),A组较B、C两组升高更明显,有统计学差异(P<0.05);三组患者术后Ccr、GFR显著降低,与术前比较差异有统计学意义(P<0.05),A、B两组较C组降低更明显,差异有统计学意义(P<0.05)。结论阿托伐他汀与水化疗法联合应用预防冠状动脉介入治疗术后对比剂肾病效果显著,值得临床推广和应用。

Study of Atorvastatin Statins Combined with Hydration Therapy for the Prevention of Contrast-Induced Nephropathy After Percutaneous Coronary Intervention （PCI）

Objective To explore the clinical value of atorvastatin statins combined with hydration therapy for the prevention of contrast-induced nephropathy （CIN） after percutaneous coronary intervention （PCI）. Methods A total of 120 patients with coronary heart disease treated with selective coronary angiography and interventional treatment were randomly divided into 3 groups. Patients in group A received conventional therapy, including aspirin, nitrates, angiotensin converting enzyme inhibitors, patients in group B received hydration therapy on the basis of conventional therapy, and patients in group C received atorvastatin statins （40 mg） combined with hydration therapy on the basis of conventional therapy. The blood urea nitrogen （BUN）, serum creatinine （Scr）, urinary microalbumin （mALB）, interleukin 18 （IL-18） were detected and the creatinine clearance rate （Ccr） and glomerular filtration rate （GFR） were calculated. Results The number of cases of CIN of the three groups were 7 （17.5%）, 4 （10.0%） and 1 （2.5%）, respectively, and the incidence of CIN in group B and group C was significantly lower than that of group A （P〈0.05）, and group C was significantly lower than that of group B （P〈0.05）. The levels of BUN, Scr, mALB and IL-18 increased significantly after surgery （P〈0.05）, and the effects were more significant in the group A （P〈0.05）. The Ccr and GFR decreased significantly after surgery （P 〈0.05）, and the effects were more significant in group A and group B （P 〈0.05）. Conclusions The function of atorvastatin statins combined with hydration therapy is significant in the prevention of contrast-induced nephropathy. It＇s worthy of application and promotion.