普罗布考联合阿托伐他汀对冠心病并发糖尿病介入治疗患者对比剂急性肾损害的影响

目的探讨普罗布考联合阿托伐他汀对冠状动脉粥样硬化性心脏病(冠心病)并发糖尿病介入治疗患者对比剂急性肾损害(contrast-induced acute kidney injury,CIAKI)的影响。方法选取2018年1月至2019年3月廊坊市第四人民医院行择期介入治疗的冠心病并发糖尿病患者260例,随机分为对照组和观察组各130例。对照组患者在水化预防基础上给予口服阿托伐他汀,观察组患者在对照组基础上加用普罗布考。比较两组患者介入治疗前后高敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)、细胞间黏附分子-1(intercellular cell adhesion molecule-1,ICAM-1)、总抗氧化能力(total antioxidant capacity,T-AOC)、一氧化氮(nitric oxide,NO)、内皮素(endothelin-1,ET-1)、几丁质酶3样蛋白1(chitinase-3-like protein,CHI3L1)、肌酐、尿素氮、估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)及CIAKI的发病率。结果(1)两组患者术前hs-CRP、ICAM-1、T-AOC、NO、ET-1、CHI3L1比较,差异无统计学意义(P>0.05);术后3 d,观察组患者hs-CRP、ICAM-1、ET-1、CHI3L1低于对照组,而T-AOC、NO高于对照组,差异有统计学意义(P<0.05)。(2)两组患者术前肌酐、尿素氮、eGFR比较,差异无统计学意义(P>0.05);术后3 d,观察组患者的肌酐、尿素氮浓度低于对照组,eGFR高于对照组,差异有统计学意义(P<0.05)。(3)介入治疗后,观察组和对照组分别有4例(3.08%)和19例(14.62%)患者发生CIAKI,两组CIAKI发病率比较,差异有统计学意义(χ2=10.73,P<0.05)。(4)多因素Logistic回归分析结果显示,普罗布考联合阿托伐他汀使用是CIAKI的保护因素。结论普罗布考联合阿托伐他汀可有效预防冠心病并发糖尿病介入治疗患者CIAKI的发生,其机制可能与二者联合用药的强力抗炎、抗氧化、改善血管内皮功能有关.

Influence of probucol combined with atorvastatin on contrast-induced acute kidney injury in patients with coronary artery disease complicated with diabetes undergoing percutaneous coronary intervention

Objectives To investigate the influence of probucol combined with atorvastatin on contrast-induced acute kidney injury(CIAKI)in patients with coronary artery disease complicated with diabetes undergoing percutaneous coronary intervention(PCI).Methods Totally of 260 patients with coronary artery disease complicated with diabetes admitted for elective PCI from January 2018 to March 2019 in The Fourth People′s Hospital of Langfang City were randomly divided into two groups:control group(n=130)and observation group(n=130).Patients in control group were given atorvastatin on the base of conventional therapy,and patients in observation group were added probucol on the base of control group.High sensitivity C-reactive protein(hs-CRP),intercellular cell adhesion molecule-1(ICAM-1),total antioxidant capacity(T-AOC),nitric oxide(NO),endothelin-1(ET-1),chitinase-3-like protein(CHI3L1),creatinine(Cr),blood urea nitrogen(BUN),estimated glomerular filtration rate(eGFR)before and after PCI and incidence of CIAKI were compared between the two groups.Results(1)There were no statistical differences of concentrations of hs-CRP,ICAM-1,NO,ET-1,CHI3L1 and level of T-AOC before PCI between the two groups(P>0.05);concentrations of hs-CRP,ICAM-1,ET-1,CHI3L1 at 3 d after PCI in observation group were significantly lower than those in control group(P<0.05),and level of T-AOC,concentrations of NO were significantly higher than those in control group(P<0.05).(2)There were no statistical differences in concentrations of Cr,BUN and eGFR before PCI between the two groups(P>0.05);concentrations of Cr,BUN at 3 d after PCI in observation group were sig?nificantly lower than those in control group(P<0.05);level of eGFR was significantly higher than that in control group(P<0.05).(3)There were 4 patients(3.08%)with CIAKI in observation group and 19 patients(14.62%)with CIAKI in control group;difference of incidence of CIAKI was statistically significant between the two groups(P<0.05).(4)Multivariate Logistic regression analysis showed that probucol combined with atorvastatin was a protective factor for CIAKI.Conclusions Probucol combined with atorvastatin can effectively prevent the happening of CIAKI in patients with coronary artery disease complicated with diabetes undergoing PCI,which may be related to the combination of strong anti-inflammatory,antioxidant and improving endothelial function.