Effect of rhBNP on renal function in STEMI-HF patients with mild renal insufficiency undergoing primary PCI

This study aims to investigate the effect of recombinant human brain natriuretic peptide (rhBNP) on renal function and contrast-induced nephropathy (CIN) incidence in ST-segment elevation myocardial infarction and heart failure (STEMI-HF) patients with mild renal insufficiency undergoing primary percutaneous coronary intervention (PCI). A total of 116 participants were randomized into rhBNP (rhBNP, n = 57) and nitroglycerin group (NIT, n = 59), receiving intravenous rhBNP or nitroglycerin from admission to 72 h after PCI. Renal function was assessed by serum creatinine (SCr), estimated glomerular filtration rate (eGFR), Cystatin-C (Cys-C) and β₂-microglobulin before and after primary PCI, and calculated the incidence of CIN within 72 h after PCI. There were no significant differences in SCr, eGFR and β₂-microglobulin between the two groups (P > 0.05, respectively). Compared with the NIT group, the total urinary volume within 72 h was higher while the level of Cys-C at 24 and 72 h after PCI was lower in the rhBNP group. rhBNP was associated with a decline in the incidence of CIN (12.28 vs. 28.81 %, P < 0.05). No differences were detected in mortality and re-hospitalization in 3 months between the two groups. The incidence of renal injury was not different between rhBNP and nitroglycerin in STEMI-HF patients with mild renal insufficiency. However, infusion of rhBNP was associated with a decline in incidence of CIN.     

术前血清白蛋白水平对急性冠脉综合征患者经皮冠状动脉介入治疗后对比剂肾病的预测价值研究

背景对于对比剂肾病(CIN),目前临床尚无特效治疗方法,因此早期识别并干预CIN高危患者对提高经皮冠状动脉介入治疗(PCI)效果、改善患者预后具有重要意义。目的探讨术前血清白蛋白水平对急性冠脉综合征(ACS)患者PCI后CIN的预测价值。方法选取2018年9月—2019年9月在徐州医科大学附属医院行PCI的ACS患者482例,根据PCI后CIN发生情况分为CIN组(n=52)和非CIN组(n=430),根据术前血清白蛋白水平四分位数间距分为Q1组(≤39.5 g/L,n=120)、Q2组(39.6~42.7 g/L,n=121)、Q3组(42.8~45.3 g/L,n=120)和Q4组(>45.3 g/L,n=121)。比较非CIN组和CIN组患者一般资料、对比剂用量及实验室检查指标,并比较不同术前血清白蛋白水平患者PCI后CIN发生率;ACS患者PCI后CIN的影响因素分析采用多因素Logistic回归分析,并绘制ROC曲线以评价术前血清白蛋白水平对ACS患者PCI后CIN的预测价值。结果(1)非CIN组和CIN组患者年龄、男性比例、体质指数、收缩压、舒张压、吸烟率、高血压发生率、糖尿病发生率及使用β-受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂、钙通道阻滞剂、他汀类药物、硝酸酯类药物者所占比例比较,差异无统计学意义(P>0.05);CIN组患者AMI发生率、使用利尿剂者所占比例、使用低分子肝素者所占比例及对比剂用量高于非CIN组(P<0.05)。(2)非CIN组和CIN组患者术前三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白、空腹血糖、白细胞计数、血肌酐、血尿酸、血尿素、胱抑素C及估算肾小球滤过率(eGFR)比较,差异无统计学意义(P>0.05);CIN组患者术前血清白蛋白、血红蛋白水平及术后eGFR低于非CIN组,术前血小板与淋巴细胞比值(PLR)及术后血肌酐、血尿酸、血尿素、胱抑素C高于非CIN组(P<0.05)。(3)Q3组患者PCI后CIN发生率低于Q1组,Q4组患者PCI后CIN发生率低于Q1组和Q2组(P<0.05)。(4)多因素Logistic回归分析结果显示,术前血清白蛋白水平〔OR=0.765,95%CI(0.700,0.837)〕、血红蛋白〔OR=0.981,95%CI(0.967,0.996)〕、PLR〔OR=1.005,95%CI(1.001,1.010)〕是ACS患者PCI后CIN的独立影响因素(P<0.05)。(5)ROC曲线显示,术前血清白蛋白水平预测ACS患者PCI后CIN的曲线下面积为0.790〔95%CI(0.751,0.826)〕,最佳截断值为40.8 g/L,灵敏度为75.0%,特异度为70.2%。结论术前血清白蛋白水平是ACS患者PCI后CIN的影响因素,且对PCI后CIN具有一定预测价值,有助于早期识别CIN高危患者。     

水化加前列地尔对老年患者介入术后肾损伤的保护作用

目的探讨水化加前列地尔对老年患者PCI术后肾损伤的保护作用及预防对比剂肾病的效果。方法选择老年冠心病患者60例。随机分为2组:对照组26例(常规水化),实验组34例(前列地尔+常规水化)。于PCI术前、术后48h、造影后第7天分别测定血肌酐、血尿素及尿β_2微球蛋白水平。结果与对照组比较,实验组患者PCI术后48h及造影后第7天血肌酐、血尿素和尿β_2微球蛋白明显降低,差异有统计学意义(P<0.05)。实验组患者对比剂肾病2例,发生率为5.9%;对照组对比剂肾病3例,发生率为11.5%,实验组对比剂肾病发生率明显低于对照组,差异有统计学意义(P<0.05)。结论在水化基础上,PCI术前使用前列地尔注射液可明显改善老年患者术后的肾脏功能,明显降低对比剂肾病的发生率。     

应用主动脉内球囊反搏对急性心肌梗死急诊经皮冠状动脉介入术后慢血流现象患者血浆脑钠肽水平及左室功能的影响

目的探讨应用主动脉内球囊反搏(IABP)对急性ST段抬高心肌梗死(STEMI)冠状动脉介入治疗术后慢血流(SCF)患者血浆脑钠肽(BNP)水平及左心室功能的影响。方法分析2008年1月—2010年12月因STEMI行PCI术后SCF现象患者28例资料,采用单双日分组方法将其中14例运用IABP治疗分为治疗组,其余14例为对照组,观察术后1h心电图梗死相关导联ST回落及术前、术后24h、术后1周BNP水平差异;治疗10d后应用彩色超声心动图测量患者左心房内径、左心室内径、左心室射血分数(LVEF);并随访3个月、6个月左心房内径、左心室内径、LVEF变化情况。结果术后1h心电图ST回落50%者对照组组占28.1%,治疗组占61%;术前两组BNP水平无明显差异,术后24h对照组为(365.1±121.6)ng/L,治疗组为(278.4±92.7)ng/L;术后1周对照组为(295.7±65.8)ng/L,治疗组为(203.8±64.7)ng/L,P<0.05。超声心动图测量两组患者恢复期LVEF值差别有明显统计学意义。结论急性STEMI患者直接PCI术后SCF现象患者应用IABP明显影响BNP水平,提高恢复期LVEF值,对心功能可能有一定的改善作用。     

他汀类药物对急性心肌梗死患者直接冠状动脉介入治疗后对比剂肾病的预防作用

目的探讨急性心肌梗死（acute myocardial infarction,AMI）患者行直接经皮冠状动脉介入（percutaneouscoronary intervention,PCI）治疗前,应用他汀类药物对于对比剂肾病（contrast-induced nephropathy,CIN）的预防作用。方法回顾性分析186例行直接PCI治疗的急性ST段抬高AMI患者的临床资料,根据入院前是否接受他汀类药物治疗,分为他汀组（42例）和非他汀组（144例）,收集其PCI治疗前和治疗后48～72 h内的血清肌酐浓度,计算内生肌酐清除率。结果186例患者中34例发生CIN,CIN发生率为18.3%;他汀组CIN发生率显著低于非他汀组,差异有统计学意义（7.1%vs.21.5%,P〈0.05）。他汀组术后血清肌酐浓度明显低于非他汀组,差异有统计学意义[（90.3±26.0）μmol/L vs.（101.5±28.4）μmol/L,P〈0.05]。术后他汀组内生肌酐清除率明显高于非他汀组,差异有统计学意义[（72.5±21.1）mL/min vs.（63.9±18.2）mL/min,P〈0.05]。多因素回归分析显示,PCI治疗前应用他汀类药物（OR 0.48,95%CI 0.11～0.89,P〈0.05）和肾功能不全（基线内生肌酐清除率〈60 mL/min）、使用主动脉内球囊反搏治疗、心源性休克是CIN的独立预测因素。结论急性AMI行直接PCI治疗的患者,术前应用他汀类药物治疗能保护肾功能,降低CIN的发生率,提示术前他汀类药物预处理可能具有预防CIN的作用。     

急性心肌梗死患者经皮冠状动脉介入治疗围术期应用重组人脑利钠肽后脑利钠肽和肌酸激酶同工酶变化及安全性观察

目的观察急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术中及术后静脉应用重组人脑利钠肽(rhBNP)48h后血浆脑利钠肽(BNP)和肌酸激酶同工酶(CK-MB)的变化及rhBNP的安全性。方法选择70例AMI患者,随机分为rhBNP治疗组(A组)和生理盐水对照组(B组)。两组患者均行直接PCI术,A组:PCI术中及术后静脉应用rhBNP,先按1.5μg/kg负荷剂量静脉推注(3min),后按0.01μg·kg~(-1)·min~(-1)静脉滴注,持续48h;B组:PCI术中及术后应用生理盐水静脉滴注同期对照。同时观察静脉应用过程中患者有无血压下降、头痛、腹部不适、恶心呕吐等。两组在PCI术前、术后检测血浆BNP及CK-MB浓度。结果 (1)B组血浆BNP浓度高峰在PCI术后24h出现。在PCI术后156h两组血浆BNP浓度[B组(137±24)ng/L,A组(115±35)ng/L]差异有统计学意义(P=0.023)。(2)A组术后60hCK-MB较B组明显降低(P0.05)。(3)相关分析显示,BNP与性别(r=0.303,P=0.024)、年龄(r=0.522,P0.001)呈正相关,与体质量(r=-0.504,P0.001)、左心室射血分数(LVEF)(r=-0.317,P=0.032)呈负相关。(4)A组在应用rhBNP中出现不良反应14例,B组为16例,差异无统计学意义(P=0.784)。结论 AMI患者PCI围术期应用rhBNP安全可行;应用rhBNP可能减轻心肌损伤;血浆BNP浓度女性较男性高,与年龄呈正相关,与体质量、LVEF呈负相关。     

阿托伐他汀对冠脉介入术后肾功能的影响

目的观察不同剂量阿托伐他汀对冠脉造影术或经皮冠状动脉介入术（PCI）术后肾功能的影响,并对其可能机制进行分析。方法纳入我院因急性冠脉综合征（ACS）接受冠脉造影术或PCI术的患者120例,随机分为阿托伐他汀常规剂量治疗组（常规组,20mg/d,n=60）和阿托伐他汀高剂量治疗组（高剂量组,术前40mg/d×3d,术后20mg/d,n=60）。术前、术后24h检测血清不规则趋化因子（FKN）的水平,术前、术后3天和术后7天检测血肌酐（Scr）、评估肾小球滤过率（eGFR）、血胱抑素（Cys）等,同时分析FKN与上述肾功能指标的相关性。结果术后24h高剂量治疗组FKN浓度低于常规剂量治疗组（P〈0.05）;术后3天高剂量组患者Scr、Cys低于常规组,而eGFR则高于常规组,存在统计学差异（P〈0.05）。两组的对比剂肾病（contrast induced nephropathy,CIN）发病率存在统计学差异（6.67%vs.16.67%,P〈0.05）。相关性分析结果显示FKN浓度与患者Scr、Cys水平呈正相关,与eGFR呈负相关（P〈0.05）。结论术前强化阿托伐他汀治疗可预防CIN,其机理可能与FKN有关。     

Contrast-induced nephropathy in patients with type 2 diabetes during coronary angiography: Risk-factors and prognostic value

AimsTo determine risk factors, prognostic, value prevention of development of contrastinduced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (T2DM).Materials and MethodsWe have retrospectively analyzed the incidence of CIN developed after PCI in 151 patients T2DM and 50 patients without diabetes. All patients were subjected to thorough clinical examination (including serum creatinine level before and 48 hours after intervention).ResultsCIN developed more frequently after PCI in patients with T2DM than in patients of the same age without diabetes at the same baseline renal function, volume of contrast media and hydration status. The risk of developing CIN in patients with T2DM is associated with: heart failure, anemia, volume of contrast media, diuretics use in the peri-procedure period, multiple coronary artery disease, need of interventional procedures. TIDM patients with CIN had faster decline of renal function, more often developed cardiovascular diseases and had lower 24 month survival rate.ConclusionsHigh risk of CIN development and its prognostic significance in patients with T2DM determine the necessity of individually evaluated risks for preventive measures during contrast media interventions.     

大剂量他汀联合水化对老年慢性肾功能不全患者造影剂肾病的影响

目的 探讨短期应用大剂量他汀联合水化治疗对合并慢性肾功能不全的老年冠心病患者造影剂肾病(CIN)的防治效果.方法 选择2011年1月至2012年6月在我院心内科住院的262例合并慢性肾功能不全的老年冠心病患者(年龄≥60岁).入选患者行经皮冠状动脉内介入治疗(PCI)术前随机(随机数字表法)分为对照组135例、大剂量他汀联合水化治疗组(试验组)127例两组,测定PCI前后血肌酐(SCr)、胱抑素C、高敏C反应蛋白(hs-CRP)水平和肾小球滤过率(GFR).结果 试验组患者PCI术后SCr、血浆胱抑素C及hs-CRP水平均显著低于对照组患者,而术后GFR高于对照组[(210.4±40.1)μmol/L比(221.3±36.2)μmol/L,P＜0.01; (6.5±1.6)mg/L比(72±2.1)mg/L,P＜0.05;(6.8±2.5)mg/dl比(7.9±.2.4)mg/dl,P＜0.05; (64.1±113)ml/min比(58.9±10.8)ml/min,P＜0.05];试验组患者造影剂肾病发生率亦显著低于对照组患者[14 (11.02％)比35(25.92％),P＜0.01].多因素logstic回归分析显示,胱抑素C及hs-CRP水平对合并慢性肾功能不全的老年冠心病患者CIN的发生具有预测意义,而短期大剂量他汀联合水化治疗则对降低CIN的发生有保护作用.结论 对合并慢性肾功能不全的老年冠心病患者,PCI术前短期给予大剂量他汀类药物联合水化可以显著减少CIN的发生.     

Predictors of contrast induced nephropathy and the applicability of the Mehran risk score in high risk patients undergoing coronary angioplasty—A study from a tertiary care center in South India

ObjectiveTo study the incidence and predictors of Contrast induced nephropathy (CIN) in high risk patients undergoing coronary angioplasty. To study the applicability of the Mehran Risk Score (MRS) in the prediction of CIN in our population.MethodsThis was a prospective observational study where patients with an estimated glomerular filtration rate (eGFR) between 30 and 60 ml/mt undergoing elective percutaneous coronary intervention (PCI) over a period of 15 months were evaluated prospectively for the development of CIN. The patients who developed CIN were then analysed for the presence of specific risk factors. The patients were categorized into the 4 risk groups based on the MRS.Results100 high risk patients underwent PCI during the study period. The incidence of CIN was 29%. On multivariate analysis, the presence of anemia (p = 0.007), increased contrast volume usage (as defined by >5* B.Wt/S.cr) (p = 0.012) and usage of loop diuretics (p = 0.033) were independently found to confer a significant risk of CIN. In patients belonging to the high Mehran risk group (MRS10- 15) and very high risk group (MRS >15) the risk of CIN was 3 fold (OR: 3.055, 95% CI: 1.18–7.94, p = 0.022) and 24 fold (OR: 24, 95% CI: 2.53–228.28, p = 0.006) higher respectively when compared to intermediate and low risk patients (MRS <10).ConclusionThe incidence of CIN in high risk patients undergoing PCI is substantially higher in our population compared to similar studies in the west. The MRS risk prediction is pertinent even in an Indian population.     

Effect of the Composition of Atherosclerotic Plaques and Rate of Platelet Aggregation on Elevation of Serum Levels of Cardiac Troponin T After Percutaneous Coronary Interventions

Purpose: Elevation of the levels of myocardial biomarkers after percutaneous coronary intervention (PCI) has prognostic value in patients with coronary heart disease. We explored the relationship between elevation of the serum level of cardiac troponin T (cTnT) after PCI and platelet aggregation rate and coronary plaque composition. Methods: Eighty patients with unstable angina pectoris underwent PCI and were divided into two groups according to serum cTnT level 24 hours after PCI: group I (cTnT ≥2 times the normal level) and group II (cTnT <2 times the normal level). Coronary plaque composition was measured with virtual histology‐intravascular ultrasound. Platelet aggregation rate was detected immediately before and 24 hours after PCI. Results: Compared with the patients in group II, patients in group I showed more unstable plaques, a larger necrotic core area (20.88 ± 8.04% vs. 15.31 ± 5.48%, P < 0.05), higher platelet aggregation rate (51.47 ± 12.72% vs. 44.78 ± 13.29%, P < 0.05), and longer stents. The serum cTnT level 24 hours after PCI was positively correlated with the necrotic core area. Conclusions: In patients with unstable angina pectoris, a large necrotic core, high rate of platelet aggregation, and stent length are predictors of cTnT elevation after PCI. (J Interven Cardiol 2012;25:433–438)     

Impact of 719Trp>Arg Polymorphism of KIF 6 Gene on Contrast Induced Nephropathy in Patients Undergoing Coronary Angiography or Percutaneous Coronary Intervention

Background:The identification of preventive strategies, such as statin therapy, is crucial for the management of contrast-induced nephropathy (CIN). Several studies showed the association between KIF6 polymorphism (replacement of Trp719 with Arg) and an increased cardiovascular risk, while others showed a correlation between ‘pleiotropic’ effects of statins and a reduction in cardiovascular events in the population with the risk allele due to the documented modulation of response to statin by KIF6 polymorphism. Aim of this study is to assess the impact of KIF6 polymorphism on the development of CIN.Methods:We analysed 1253 consecutive patients undergoing coronary angiography/PCI. Serum creatinine was collected at baseline, 24 and 48 hours after contrast exposure. We identified the different allelic patterns and assessed the incidence of CIN (absolute increase of 0.5mg/dL or relative >25% in creatinine at 24 and 48h).Results:KIF6 Arg mutation was found in 669 patients (heterozygotes n = 525, homozygotes n = 144). The total prevalence of CIN was 12.5% and we did not find any association between KIF6 polymorphism and CIN development (11.3%, 13.7%, 13.2% p = 0.30). At subgroups analysis among statin ‘naïve’ patients we found a higher prevalence of CIN in homozygous patients as compared to wild-type (20.7% vs 11.3%, p = 0.05), while opposite results were observed among patients with statin therapy (8.6% vs 13.2%, p = 0.28).Conclusion:KIF6 homozygous Arg was associated with a significant increase in the risk of CIN only among statin naive patients. Future studies are needed to evaluate the beneficial effects of statin especially in this subset of patients.     

冠心病患者冠脉介入治疗术后对比剂肾病的相关因素和尿NGAL对对比剂肾病的早期诊断价值

目的 探讨尿中性粒细胞明胶酶相关载脂蛋白（NGAL）对冠心病患者经皮冠脉介入（PCI）治疗术后对比剂肾病（CIN）的早期诊断意义以及CIN的相关因素。 方法 选取入院后行PCI的冠心病患者208例，其中并发高血压病118例、并发糖尿病106例、并发慢性心力衰竭28例、慢性肾功能不全24例，检测术前及术后4、24、48和72 h血清肌酐（SCr）、尿NGAL的含量，对CIN进行诊断性评价。观察CIN的发生率，同时观察住院至出院1个月内的主要心血管不良事件（MACE）。 结果 208例患者中术后发生CIN31例，CIN发生率为14.9%；CIN组糖尿病和慢性心力衰竭的患病率以及MACE发生率显著高于非CIN组（P<0.05）。CIN组和非CIN组术前尿NGAL含量水平相似，两组比较无统计学意义，CIN组术后4 h尿NGAL开始升高，且逐渐升高至72 h，与术前比较有统计学意义（P<0.05）；非CIN组术后尿NGAL较术前升高不明显；两组术后同时段尿NGAL的含量比较具有统计学意义（P<0.05）。ROC曲线分析发现，术后尿NGAL各时段4、24、48和72 h的曲线下面积（AUC）分别为0.932、0.946、0.957和0.975，诊断的敏感性为94%，特异性为100%；术后SCr各时段相应的AUC分别为0.588、0.562、0.842和0.879，诊断CIN的敏感性、特异性明显低于尿NGAL。Logistic多因素回归分析显示:糖尿病、SCr、肾小球滤过率估算值（eGFR）[<60 ml/(min·1.73 m2)]、NGAL、慢性心力衰竭[左室射血分数（LVEF）<35%]、糖化血红蛋白(>9.5%)是CIN的危险因素。 结论 尿NGAL对PCI治疗术后CIN具有一定的早期诊断价值。并发糖尿病、慢性肾功能不全、慢性心力衰竭等为CIN的相关因素。发生CIN后MACE明显增高。      

重组人脑利钠肽和硝普钠治疗老年人慢性充血性心力衰竭急性期的疗效对照研究

目的 比较重组人脑利钠肽(rhBNP)和硝普钠治疗老年人慢性充血性心力衰竭(CHF)急性期的临床疗效,对心功能、血清脑利钠肽(BNP)、去甲肾上腺素(NE)、内皮素-1(ET-1)及抗利尿激素(ADH)水平的影响.方法 89例年龄65～85岁的CHF急性期患者随机分为rhBNP组(47例)和硝普钠组(42例),观察两组患者治疗前、后的临床疗效、心功能的变化和血清BNP、NE、ET-1及ADH水平的变化.结果 rhBNP组显效率51.1%(24例),总有效率95.7%(45例),均高于硝普钠组,分别为26.2%(11例)及66.7%(28例),差异有统计学意义(P＜0.05和P＜0.01);无效率4.3%(2例),低于硝普钠组33.3%(14例),差异有统计学意义(P＜0.01);rhBNP组死亡1例,硝普钠组死亡3例;rhBNP组治疗后2周左心室射血分数值较治疗前升高,分别为(46.2±9.5)%与(38.1±6.0)%,差异有统计学意义(P＜0.05);rhBNP组治疗后2周血清BNP水平较硝普钠组下降(P＜0.05);rhBNP组治疗后24 h及治疗后2周血清BNP、NE均较基线值下降(P＜0.01),治疗后2周较治疗后24 h进一步降低(P＜0.01);rhBNP组治疗后2周血清ET-1水平较硝普钠组下降(P＜0.05),rhBNP组治疗后24 h血清ET-1与基线值比较差异无统计学意义(P＞0.05),但治疗后2周较基线值及治疗后24 h下降(均P＜0.01);两组治疗前、治疗后24 h及治疗后2周血清ADH水平比较差异均无统计学意义(P＞0.05),rhBNP组发生头痛2例(4.3%),低血压7例(14.9%),均低于硝普钠组[分别为8例(19.0%)及10例(23.8%)],差异有统计学意义(P＜0.05).结论 rhBNP能明显改善CHF急性期患者心室收缩功能,拮抗神经-内分泌激素的过度激活,可安全、有效用于老年CHF患者急性期的治疗.

Abstract：

Objective To compare the curative effects between recombinant human brain natriuretic peptide (rhBNP) and sodium nitroprusside in treatment of the acute attack of elderly patients with chronic heart failure (CHF), and probe the impacts of rhBNP on the heart function,serum B-type natriuretic peptide (BNP), norepinephrine (NE), endothelin 1 (ET-1) and antidiuretic hormone (ADH) levels. Methods The 89 patients aged 65-85 years at acute attack stage of CHF were randomized into two therapy groups: rhBNP group (n= 47) and sodium nitroprusside group (n=42). The clinical effects, heart function, serum BNP, NE, ET-1 and ADH changes were observed before and after the treatment. Results After 24 hours of treatment, the efficacy rate and total effective rate were higher in rhBNP group than in sodium nitroprusside group (51.1% vs. 26.2 %,95.7% vs. 66. 7%, respectively, P＜0. 05 and P＜0. 01), and non-efficacy rate in rhBNP group was lower (4.3% vs. 33. 3%, P＜0. 01). There was one death case in rhBNP group and three in sodium nitroprusside group. In rhBNP group, left ventricular ejection fraction values increased after 2 weeks of treatment [(46.2± 9.5)% vs. (38.1 ±6.0)%], P＜0.05. Serum BNP level significantly decreased in rhlBNP group than in sodium nitroprusside group after 2 weeks of treatment (P＜0.05).In rhBNP group, serum BNP and NE levels decreased 24 hours and 2 weeks after treatment (P＜0. 01) and the levels furtherly reduced after 2 weeks (P＜0.01). Serum ET-1 level decreased in rhBNP group than in sodium nitroprusside group 2 weeks after treatment (P＜0.05). In rhBNP group, there was no significant difference in serum ET-1 level between baseline and 24 hours after treatment (P＞ 0. 05), but the ET-1 level decreased 2 weeks after treatment as compared with 24 hours after treatment (P＜0.01). There were no significant differences between the two groups before and after treatment (P＞0.05). Incidences of headache and hypotension were lower in rhBNP group than in sodium nitroprusside group (4.3% vs. 19.0%, 14.9% vs. 23.8%, both P＜0.05),Conclusions RhBNP can be safely and effectively used for acute attack of CHF.     

不稳定型心绞痛患者介人术后对比剂肾病的危险因素

目的探讨不稳定型心绞痛患者冠状动脉(冠脉)介入诊断及治疗术后对比剂肾病(CIN)的发生率及危险因素。方法连续入选2007年1～8月因不稳定型心绞痛入院并接受择期冠脉介入手术的患者232例。排除标准:(1)血压<120/70 mm Hg;(2)心功能(NYHA)分级>Ⅲ级。术中使用低渗非离子型对比剂碘普罗胺。介入术后24～72 h血肌酐(Scr)较基础值增高25%或44.2 μmol/L定义为CIN。分析CIN发生率与各项危险因素的相关性。结果 CIN总发生率为14.7%。冠脉钙化、术前Scr水平≥132.6 μmol/L、内生肌酐清除率(Ccr)<60 ml/min、NYHA Ⅲ级、糖尿病及年龄≥70岁的患者CIN发生率均明显增高。多变量回归分析显示,基线Scr≥132.6μmol/L、Ccr<60 ml/min、NYHA Ⅲ级与CIN的相关性最强。结论不稳定型心绞痛患者接受冠脉介入术后CIN是常见的并发症;高龄、肾功能不全、心功能不全、糖尿病及造影发现冠脉钙化是CIN发生的危险因素。     

经皮冠状动脉介入术相关的围手术期心肌梗死对远期心功能的影响

目的:观察经皮冠状动脉介入术(PCI)相关的围手术期心肌损伤患者血清脑钠肽(BNP)和心功能的变化,并评估围手术期心肌梗死对远期心功能的影响。方法:根据1 187例行PCI的冠心病患者术前、术后12~24 h血清心肌钙蛋白I(cTn I)分为无心肌损伤组、心肌损伤组和心肌梗死组。检测术前、术后3~6 h、12~24 h的血清BNP,比较术前、术后1年的超声心动图左心室射血分数(LVEF)值及舒张早期左房室瓣血流速度与舒张晚期左房室瓣血流速度比值(E/A值)。观察再次入院率、再次心肌梗死及再次血管重建的发生率。结果:PCI相关心肌梗死的发生率为8.59%(102例),心肌损伤的发生率为14.15%(168例)。心肌梗死组PCI术前及术后3~6 h、12~24 h血清BNP分别为(30±22)、(70±36)、(211±59)ng/L;心肌损伤组为(33±23)、(57±29)、(118±60)ng/L;无心肌损伤组为(32±33)、(42±38)、(66±55)ng/L。术后BNP水平较术前显著上升(P<0.05),且心肌梗死组和心肌损伤组术后BNP水平高于无心肌损伤组(P<0.05)。1年的随访中,因心绞痛或心力衰竭再次入院率、再次心肌梗死及再次血管重建的发生率在3组中有显著差异(P     

The relationship between pre-procedural elevated arterial lactate and contrast-induced nephropathy following primary percutaneous coronary intervention

BackgroundRisk stratification has been one of the main steps in preventing contrast-induced nephropathy (CIN), which is a common complication after percutaneous coronary intervention (PCI). Elevated arterial lactate is a biomarker indicating severe disease condition and post-intervention complications. The relationship between lactate and CIN has not been established. This study is performed to investigate the relationship between elevated arterial lactate level and contrast-induced nephropathy (CIN).MethodsPatients diagnosed with ST-segment elevated myocardial infarction (STEMI) were prospectively enrolled, with lactate measured within 0.5–1 hours before primary percutaneous coronary intervention (PCI). Patients with cardiopulmonary resuscitation, any forms of severe anaerobic condition, or end-stage renal disease undergoing dialysis were excluded. CIN was defined as an increase in serum creatinine ≥0.5 mg/dL or 25% within 72 hours after PCI. The Mehran Risk Score (MRS) is widely regarded as a classic risk model for CIN and the risk factors of MRS were applied in our multivariate regression analysis.ResultsOf the 227 enrolled patients, 47 (20.7%) developed CIN according to the definition. The mean lactate level was higher in the CIN group than in the non-CIN group (2.68±2.27 vs. 1.74±1.94, P<0.001). The arterial lactate level ≥2.0 mmol/L had 57.5% sensitivity and 75.6% specificity in predicting CIN. The performance of the lactate level in discriminating CIN was similar to that of the MRS (AUC_lac =0.707 vs. AUC_MRS =0.697, P=0.86). After adjusting for other risk factors, lactate ≥2.0 mmol/L still significantly predicted CIN (odds ratio =3.77, 95% CI, 1.77–7.99, P=0.001).ConclusionsAn arterial lactate level of ≥2.0 mmol/L is associated with CIN in STEMI patients after primary PCI.     

重组人脑利钠肽在心衰治疗中对肾功能影响的研究

目的 观察重组人脑利钠肽在治疗心衰中对肾功能的影响.方法 回顾性分析在我院住院诊断为心衰的患者75例,随机分为两组：rhBNP组35例,在常规治疗的基础上加用rhBNP;常规治疗组40例,给予常规治疗.重组人脑利钠肽按0.0075 μg＆#183;kg-1＆#183;min-1微量泵静脉泵入,每天1次,每次持续约10 h,7d为一疗程,分别记录治疗前和7d后患者的24h尿量、尿素氮、血清肌酐、血清胱抑素、肾小球滤过率及NT-proBNP的变化.结果 治疗后与常规治疗组比较,rhBNP组的总有效率（94.3％比62.5％）、24 h尿量[（965.34±171.81）ml比（785.27±143.45）ml]、尿素氮[（7.42±2.33）mmol/L比（12.89±3.16）mmol/L]、血清肌酐[（91.53±8.21） μmol/L比（232.68±68.95） μmol/L]、血清胱抑素C[（1.55±0.11）mg/L比（3.25±1.87）mg/L],24h肌酐清除率[（45.2±5.6）ml/min比（34.1±2.6）ml/min]、NT-proBNP[（1516.43±431.52）pg/ml比（3451.1±1314.2）pg/ml]差异均有统计学意义（P＜0.05）.结论 重组人脑利钠肽在心衰患者治疗中疗效安全有效,并能改善肾功能.     

阿托伐他汀对初诊不稳定型心绞痛患者介入治疗术后C-反应蛋白水平的影响及意义

目的探讨阿托伐他汀对初诊不稳定型心绞痛患者介入治疗术（PCI）后c-反应蛋白水平的影响及意义。方法30例初诊不稳定型心绞痛患者拟行PCI,随机分为阿托伐他汀组及对照组。阿托伐他汀组患者于术前3d开始服用阿托伐他汀40mg／d,介入术中使用低渗非离子型对比剂。术后全部患者立即接受水化治疗12h。入院时及术后第1天、第3天、第7天监测血清肌酐水平,入院时及术后第7天查c-反应蛋白水平。结果治疗组对比剂肾病发生率低于对照组（3％比13％,P〈0．05）。术后第1天、第3天、第7天血清肌酐水平（umol／L）均低于对照组（94．38±22．16、95．78±19．78、90．36±21．67比98．34±21．45、110．21±21．46、96．22±20．18,P〈0．05）。两组治疗前、后C-反应蛋白水平（mg／L）比较差异有统计学意义（13．68±0．45比10．28±0．23,13．45±0．34比12．14±0．33,P〈0．05）,治疗组较对照组改善更显著（P〈0．05）。结论初发不稳定型心绞痛接受PCI的患者在围手术期使用阿托伐他汀具有保护肾功能的作用。     

The Feasibility and Safety of Ambulatory Percutaneous Coronary Interventions in Complex Lesions

BackgroundThe safety and feasibility of ambulatory PCI has been demonstrated in selected patients with “simple” lesions, but it is not well known whether it could be applied in more “complex” scenarios.MethodsMain objective is to assess the feasibility and safety of ambulatory complex PCI. Prospective multicentre registry of 1047 consecutive patients planned for ambulatory trans-radial PCI. Outcomes in patients with “complex angioplasty” (CA group: 313 (30%)) were analysed and compared with those of “simple angioplasty” (SA group: 734, 70%). The feasibility (% of patients finally discharged) and safety (MACE at 24 h and at 1 month) were compared between groups. We also analyse admissions, visits to the emergency department and minor vascular complications.ResultsFeasibility was higher for SA (80.6% vs. 63.6%, OR 1.89, 95% CI 1.52–2.35, p < 0.001). Ambulatory PCI was very safe in both groups. In CA no MACE occurred at 24 h (vs. 0.17% SA) or 30 days (vs. 0.68% in SA). There were also no differences in re-admissions, visits to the emergency department or minor vascular complications (there was a non-significant tendency to higher rate of radial occlusion at 1 month in the CA group, 5.5% vs. 2.7%, p: 0.07).ConclusionsThe feasibility of ambulatory PCI in selected patients with complex lesions is lower than in simple lesions, however when it is possible, it is as safe as in selected patients with simple lesions.