卡托普利对老年冠心病患者造影剂相关肾损害的保护作用

目的观察卡托普利对冠状动脉介入诊疗术后造影剂肾病(CIN)的预防作用。方法选择2011年1月—2012年12月在北京安贞医院行冠状动脉造影或介入治疗的冠心病患者123例,年龄均≥60岁,随机分为对照组64例和干预组59例。2组在水化基础上,分别于应用造影剂前7 d至术后2 d口服安慰剂或卡托普利,观察2组应用造影剂后肾小球功能及CIN的发生情况。结果与造影前相比,对照组和干预组造影后48 h血清肌酐(SCr)水平明显增高,肌酐清除率(CCr)、肾小球滤过率(CFR)则明显降低(P<0.05),但干预组的肾小球功能损伤程度均轻于对照组(P<0.05);造影后72 h,2组上述指标较造影后48 h有明显改善(P<0.05),干预组可基本恢复至造影前水平,但对照组的血清GFR、SCr和CCr与造影前水平比较差异仍有统计学意义(P<0.05),且与干预组比较差异亦有统计学意义(P<0.05)。CIN总发生率为4.87%(6/123),干预组CIN发生率明显低于对照组(3.39%vs 6.25%,P<0.05)。结论造影剂可影响患者的肾小球功能,卡托普利对老年冠心病患者造影剂相关肾损害具有一定的预防保护作用。

Protective effect of captopril against contrast-induced nephropathy in eider patients with coronary heart disease

Objective To evaluate the protective effect of captopril against contrast-induced nephropathy in elder pa- tients with coronary heart disease. Methods A total of 123 elder patients（ 〉60 years） with coronary heart disease undergoing coronary artery angiography were randomly assigned into captopril group and control group to receive captopril or placebo, re- spectively, before and after administration of the contrast agent. Results In both groups, the contrast agents obviously affec- ted the renal functions of the patients （ P 〈 0.05 ）. At 48h after contrast administration, the level of serum creatinine was sig- nificantly higher in captopril group than in the control group, while creatinine clearance rate and glomerular clearance rate was lower （ P 〈 0.05 ）. At 72h after contrast administration, the glomerular and tubular functional parameters were all superior in both groups. Of the 123 patients, 6 experienced CIN, and the overall incidence was 4.87% （6/123）. The incidence of con- trast agent induced nephropathy was significantly lower in eaptopril group than in the control group（3.39% vs 6.25% , P 〈 0.05 ）. Conclusion Captopril offers protection against radiographic contrast agent induced renal injury in elderly patients with coronary heart disease.