强化他汀治疗对经皮冠状动脉介入治疗后患者肾损伤的保护作用

目的研究强化他汀治疗对经皮冠状动脉介入治疗(PCI)后肾功能的保护作用和预防对比剂肾病(CIN)的效果,探讨其可能机制。方法 228例接受择期PCI的急性冠脉综合征(ACS)患者,随机分为标准他汀治疗组(SSG,n=115)和强化他汀治疗组(ISG,n=113)。于PCI术前7d开始,SSG组患者口服20mg/d辛伐他汀,ISG组患者则口服80mg/d辛伐他汀。于PCI术前、术后24、48h分别测定血清肌酐水平,按Cochcroft-Gault公式计算肌酐清除率。于PCI术前、术后24h分别测定血清高敏C反应蛋白(hs-CRP)、P选择素和细胞间黏附分子1(ICAM-1)水平。结果 PCI后血肌酐水平显著升高,并于术后24h达高峰,然后逐渐下降,术后48hISG组血肌酐水平显著回降(与术后24h比较P0.001)至术前水平(P=0.94),而SSG组血肌酐水平未显著回降(与术后24h比,P=0.11)。PCI术后24、48h,ISG组的血肌酐水平均显著低于SSG组(术后24h,P0.05;术后48hP0.001)。PCI术后,两组肌酐清除率均显著降低,最低值出现在术后24h,然后逐渐回升。术后48h,SSG组肌酐清除率显著回升(与术后24h相比,P=0.03),但仍低于术前水平(P0.001),而ISG组术后48h显著回升(与术后24h相比,P0.001)并恢复到术前水平(P=0.87),在术后24、48h,ISG组肌酐清除率的回升程度均显著高于SSG组(均P0.001)。虽然PCI术后血清hs-CRP、P选择素和ICAM-1水平均显著升高(均P0.001),但ISG组低于SSG组(均P0.001)。结论与标准剂量他汀治疗相比,PCI前使用强化剂量他汀治疗可进一步保护PCI术后肾脏功能,降低CIN的发生率。这种益处伴随有血清hs-CRP、P选择素和ICAM-1水平的显著降低。

The protective effects of intensive statin pretreatment on renal function in patients with acute coronary syndrome undergoing percutaneous intervention

Objective To evaluate the protective effects of higher dose statin on renal function and the incidence of contrast induced nephropathy (CIN) and to probe its possible mechanisms.Methods Two hundreds and twenty eight patients with acute coronary syndrome (ACS) undergoing delayed percutaneous coronary intervention(PCI) were randomly divided into standard statin (SSG,n=115) and intensive statin groups (ISG,n=113).Patients in SSG group were given simvastatin 20 mg/d and patients in ISG were given simvastatin 80...