不同剂量阿托伐他汀改善对比剂所致肾功能损害

目的探讨不同剂量阿托伐他汀对急性冠状动脉综合征(ACS)患者接受经皮冠状动脉介入术(PCI)因对比剂引起的肾功能损害的缓解作用及其可能机制。方法 80例接受PCI的ACS患者随机分为两组,术前2～3天每晚顿服阿托伐他汀40mg(40mg他汀组,n=40)或20mg(20mg他汀组,n=40)。分别于术前8h、术后第1天、第2天测定血超敏C反应蛋白(hsCRP)、胱抑素C(CysC)、血清肌酐(Scr)、血尿素氮(BUN),检测尿α1-微球蛋白(α1-MG)、转铁蛋白(TRF)、微量白蛋白(mALB),计算肌酐清除率(Ccr)和肾小球滤过率(GFR),并进行统计学分析。结果①PCI术后,40mg他汀组中未发现对比剂肾病(CIN)病例,20mg他汀组中1例患者发生CIN(2.50%)。②与术前相比,术后第1天两组患者的α1-MG、Scr及CysC均明显升高(P均0.05),Ccr及GFR明显降低(P均0.05);与术后第一天比,术后第二天两组患者的α1-MG、Scr及CysC均明显降低(P均0.05),而Ccr及GFR明显升高(P均0.05)。③与术前相比,两组患者术后第1天hsCRP均明显升高(P均0.05);与术前第1天相比,术后第2天hsCRP均无明显变化(P均0.05)。④组间相比,术前及术后两组患者BUN、TRF、mALB、Scr、Ccr、CysC、GFR及hsCRP的差异均无统计学意义(P均0.05)。结论 PCI术前2～3天服用阿托伐他汀可有效缓解对比剂所致肾功能损害,其作用机制可能与减轻炎症反应、改善血管内皮功能有关。

Effect of different doses of Atorvastatin in contrast-induced nephropathy

Objective To observe the mitigative effect and mechanism of different doses of Atorvastatin on renal impairment caused by contrast agent in patients with acute coronary syndrome（ACS）who underwent percutaneous coronary intervention（PCI）.Methods A total of 80 ACS patients underwent PCI were randomly divided into 20 mg Atorvastatin group（n=40）and 40 mg Atorvastatin group.Patients took 40 mg or 20 mg Atorvastatin daily 2 or 3 days before PCI.The levels of high-sensitivity CRP（hsCRP）,cystain C（CysC）,serum creatinine（Scr）,blood urea nitrogen（BUN）,as well as urinary α1-microglobulin（α1-MG）,transferring（TRF）and microalbumin（mALB）were detected at 8 h before and 1 and 2 days after PCI,respectively.The creatinine clearance rate（Ccr）and glomerular filtration rate（GFR）were calculated,and the statistical analysis was performed.Results ①None of CIN patient was not found in 40 mg Atorvastatin group,while the incidence of CIN was 2.50% in 20 mg Atorvastatin group.②α1-MG,Scr and CysC were significantly increased in both 2 groups at 1 day after PCI（all P0.05）,while Ccr and GFR were significantly decreased（both P0.05）.α1-MG and CysC of two groups significantly decreased 2 days after PCI（all P0.05）,as well as Ccr and GFR were significantly increased at the same time（both P0.05）.③One day after PCI,the hsCRP levels of two groups were significantly higher than those of preoperation（all P0.05）.No statistical difference was found between the hsCRP level at 1 day and 2 days after PCI in both two groups.④There was no significant difference of BUN,TRF,mALB,Scr,Ccr,CysC,GFR and hsCRP between two groups（all P0.05）.Conclusion Pretreatment with Atorvastatin 2 to 3 days before PCI can effectively alleviate the renal impairment caused by contrast agent.Its mechanism may relate to the relief of anti-inflammation and the improvement of vascular endothelial function.