培哚普利对冠脉介入术后对比剂肾病的影响

目的观察培哚普利对冠状动脉介入术后对比剂肾病（CIN）发生的影响。方法采用前瞻性、开放性、随机对照研究方法，并依估算肾小球滤过率（eGFR）不同将334例行冠脉介入的冠心病患者分为4组。A组（eGFR≥90ml·min-1·1．73m‘）：A1治疗组122例，A2对照组118例；B组（60ml·min-1·1．73m。≤eGFR〈90ml·rain-1·1．73m一2）：B1治疗组48例，B2对照组46例。所有患者围手术期均给予常规水化。对照组于冠脉介入前后5d停用培哚普利，治疗组则持续使用。测定介人前后肾功能变化，观察CIN的发生情况。结果介入术后第3天，各组血肌酐、尿素氮均升高，A2对照组升高较Al治疗组明显。Al治疗组同A2对照组相比，其CIN发生率明显降低（P〈O．05）；而B1治疗组与B2对照组相比，CIN发生率差异无统计学意义。结论培哚普利对对比剂肾病的作用与基础肾功能有关，对肾功能正常的患者，培哚普利可降低对比剂肾病的发生率；而对肾功能受损患者，培哚普利无预防CIN作用。

The effect of perindopril on contrast-induced nephrology in patients undergoing percutaneous coronary intervention

Objective To investigate the effect of perindopril on contrast-induced nephrology （CIN） in patients undergoing percutaneous coronary intervention. Methods In this prospective, open-label, randomized controlled study, 334 cases with coronary arterial disease undergoing percutaneous coronary interventions were enrolled and divided into four groups according to estimated glomerular filtration rate （eGFR）, A group （eGFR I〉 90 ml~min-~＇l.73m-2）： A1 therapy group（122 cases）, A2 control group（ll8 cases）, B group（60 ml~min-~＇l.73m-~〈 eGFR〈90 ml~min-1~ 1.73m-Z）： BI therapy group （48 cases）, B2 control group （46 cases）. All patients received 0.9% NaC1 injection （conventional hydration） in perioperative period. Perindopril was discontinued in the control group five days before and after percutaneous coronary interventions, otherwise perindopril was continued in the therapy group. Renal function was measured before and after operations, and the incidence of CIN was observed. Results Plasma serum ereatinine and urea nitrogen in all groups were increased three days after operations, which were increased more significantly in A2 control group compared with A1 therapy group. In contrast to A2 control group, the incidence of CIN in A1 therapy group induced significantly （P〈0.05）. And there was no significant difference in the incidence of CIN between BI therapy group and B2 control group. Condusion The effect of perindopril on CIN depends on basic renal function of patients. In patients with normal renal function, perindopril could reduce the ineidence of CIN, but no prophylactic effect in patients with impaired renal function.