强化阿托伐他汀治疗对急诊经皮冠脉介入术后造影剂肾病与炎症反应的干预作用

目的探讨强化阿托伐他汀治疗对急诊经皮冠脉介入治疗（PCI）后造影剂肾病（CIN）与炎症反应的干预作用。方法选择急性心肌梗死并行急诊PCI患者171例为研究对象,低剂量组87例,术前和术后均给予阿托伐他汀20mg口服;高剂量组84例,术前给予阿托伐他汀80mg口服,术后3d40mg口服,以后维持20mg口服。分别于术前和术后测定血清肌酐（SCr）、胱抑素C（Cystatin C）、高敏C反应蛋白（hs-CRP）、表皮生长因子受体（EGFR）、白介素-6（IL-6）以及肿瘤坏死因子-α（TNF-α）水平。结果术后48h高剂量组SCr水平显著低于低剂量组（P=0.019）,术后72h低剂量组患者EGFR显著低于高剂量组（P=0.022）,术后24h高剂量组Cystatin C显著低于低剂量组（P=0.006）;低剂量组CIN发生率显著高于高剂量组（P=0.039）。高剂量组患者术后各炎症反应指标均显著低于低剂量组（P〈0.01）。多变量Logistic回归分析显示,造影剂用量≥150mL是CIN发生的独立危险因素（P=0.007,OR=1.571,95%CI：1.087-7.813）,高剂量阿托伐他汀是CIN发生的保护因素（P=0.016,OR=0.756,95%CI：0.341-0.947）。结论急诊PCI前强化阿托伐他汀治疗可有效预防CIN的发生,其机制可能与阿托伐他汀抑制炎症反应相关。

The Intervention of High-Dose Atorvastatin Therapy to the Inflammatory Reaction and Contrast-Induced Nephropathy in Patients Undergoing Emergency Percutaneous Coronary Intervention Operation

Objective To investigate the effect of the high-dose atorvastatin therapy to the inflammatory reaction and contrast-induced nephropathy （CIN） in patients undergoing emergency percutaneous coronary intervention （PCI）. Methods A total of 171 patients with acute myocardial infarction undergoing emergency PCI were randomly divided into the low-dose atorvastatin group （LDA group： 20 mg p.o. pre-PCI and post-PCI, n=87） and the high-dose atorvastatin group （HAD group： 80 mg p.o. pre-PCI and 40 mg post-PCI, n=84）. Then serum creatinine （SCr）, Cystatin C, high-sensitivity C-reactive protein （hs-CRP）, interleukin-6 （IL-6）, tumor necrosis factor-α （TNF-α） and EGFR were measured before and after PCI. Results In HDA group, the levels of SCr were significantly lower after PCI for 48 h（P=0. 019）, and the levels of cystatin C were also significantly lower at 24 h after PCI compared with LDA group （P=0. 006）. A total of 5. 59% patients in HAD group developed CIN versus 17.24% in LDA group （P=0. 039）. The levels of hs-CRP, IL-6 and TNF-α were significantly higher in LDA group compared with HDA group （P〈0.01）. Multivariable logistic regression analysis showed that contrast volume 150 mL was the independent risk factor of CIN （P=0. 007, OR=1. 571, 95% CI： 1. 087-7. 813） and atorvastatin was associated with a decreased risk of CIN （P=0. 016, OR=0. 756, 95%CI： 0. 341-0. 947）. Conclusion High- dose atorvastatin loaded in the emergency room can prevent CIN effectively in which mechanism may relate to the anti-inflammation of atorvastatin.