急诊PCI术前强化阿托伐他汀治疗对造影剂肾病的预防作用

Prevention effects of loading-dose atorvastatin before emergency PCI on contrast induced nephropathy

目的探讨急诊PCI术前给予80 mg阿托伐他汀强化治疗对ST段抬高心肌梗死(STEMI)患者术后造影剂肾病(CIN)的影响及其可能的机制。方法入选拟行急诊经皮冠状动脉介入术(PCI)的STEMI患者,随机分为三组:A组(术前给予阿托伐他汀80 mg,术后40 mg/d);B组(术前不服用他汀类药物,术后给予阿托伐他汀40 mg/d);C组(术前不服用他汀类药物,术后给予20 mg/d),观察三组CIN发生率及术后血肌酐(Cr)、超氧化物歧化酶(SOD)和丙二醛(MDA)变化情况。结果最终入选384例研究对象,其中A组131例,B组124例,C组129例。A、B、C三组患者术后CIN发生率分别为6.8%、16.9%、17.8%,三组CIN发生率差异具有统计学意义(P<0.05),A组CIN发生率显著低于B组和C组(P<0.05),而B、C两组间差异无统计学意义(P>0.05)。术后24 h、3 d、7 d时SOD、MDA水平在三组间差异具有统计学意义(P<0.05),A组明显低于B、C两组(P<0.05),B、C两组比较无统计学差异(P>0.05);术后1月SOD及MDA三组间差异无统计学意义(P>0.05)。术后随访1个月,药物不良反应组间差异无统计学意义(P>0.05)。结论 STEMI患者急诊PCI术前给予负荷剂量阿托伐他汀80mg治疗可明显降低CIN发生率,其机制可能与减少氧化应激作用相关。

Objective To explore the effects of loading-dose atorvastatin on contrast induced nephropathy(CIN) in ST-segment elevation myocardial infarction (STEMI) patients. Methods STEMI patients who prepared foremergency PCI were randomly divided into three groups: Group A (received atorvastatin 80 mg loading dose beforePCI and followed by 40 mg/d), Group B (received atorvastatin 40 mg/d after PCI) and Group C (received atorvastatin20 mg/d after PCI). The incidence of CIN was calculated and compared among three groups. In addition, Serumcreatinine (Cr), superoxide dismutase (SOD) and malondialdehyde (MDA) were measured. Results 384 patientswere enrolled and randomly divided into three groups (Group A: n=131; Group B: n=124; Group C: n=129). Nodifferences were found in baseline characteristics (P>0.05). Incidence of CIN in in Group A was lower than those inGroup B or Group C (P<0.05). The levels of SOD and MDA in Group A were significantly higher than those in GroupB or Group C on 24 hours, 3rd day and 7th day after emergency PCI (P<0.05), but no differences were seen amongthree groups 1 month after emergency PCI (P>0.05). No difference of severe adverse reactions was observed duringthe follow-up period. Conclusion For STEMI patients who were performed for emergency PCI, administration of80 mg atorvastatin before emergency PCI reduced the incidences of CIN. It could be related with the anti-oxidativeeffect of atorvastatin.