阿托伐他汀改善对比剂对肾功能的短期影响

Atorvastatin attenuated contrast induced renal function damage

目的观察阿托伐他汀对冠状动脉造影患者肾功能、尿微量蛋白及超敏C反应蛋白（hsCRP）改变的影响。方法120例单纯冠状动脉造影的患者随机分为他汀组（60例）或对照组（60例），他汀组于冠状动脉造影术前2-3d始每晚顿服阿托伐他汀20mg，对照组未服用阿托伐他汀及其他调脂类药。所有患者分别于术前、术后第1天、第2天测定血清肌酐（Scr）及尿素氮（BUN）；留尿标本检测尿α1-微球蛋白（α1-MG）、尿转铁蛋白（TRF）和尿微量白蛋白（mALB）；测血浆胱抑素C（CysC）、hsCRP，并根据Cockcroft-Gauh公式和GFR（ml／min）=74.835／Cys C^1.333公式分别计算出肌酐清除率（Ccr）和肾小球滤过率（GFR）。结果（1）对照组：与术前相比，术后第1天α1-MG、TRF、mALB、CysC及hsCRP均有显著升高（P〈0.01）；与术后第1天比较，术后第2天α1-MG、TRF、mALB、CysC均有显著降低（P〈0.01），但α1-MG、CysC仍高于术前水平（P〈0.01），而TRF、mALB已恢复到术前水平（P〉0.05）；术后第2天hsCRP与术前第1天相比无明显变化（P〉0.05）。（2）他汀组：与术前比较，术后第1天及第2天α1-MG、TRF、mALB、CysC均无明显变化（P〉0.05）；术后第1天hsCRP显著升高（P〈0.01）；术后第2天hsCRP与术前第1天相比无明显变化（P〉0.05）。（3）与他汀组相比较：对照组术后第1天α1-MG、TRF、mALB、CysC及hsCRP均显著升高（P〈0.01）；术后第2天CysC、α1-MG及hsCRP仍显著升高（P〈0.01），但TRF、mALB均无统计学差异（P〉0.05）。两组术前、术后BUN、Scr、Ccr均无明显变化（P〉0.05）。结论对比剂可造成轻微的一过性肾功能损害。阿托伐他汀于冠状动脉造影术前2-3d给药，可能具有减轻炎症反应、改善患者一过性蛋白尿及GFR降低的作用，提示可能有预防对比剂。肾病的作用。

Objective To study the effects of atorvastatin on contrast induced renal function change and plasma hsCRP in patients undergoing coronary angiography. Methods 120 patients who underwent coronary angiography were randomized to receive atorvastatin （20 mg/qn, n = 60） or no atorvastatin （ n = 60） treatment 2 to 3 days before coronary angiography. Urinary α1-MG, TRF and mALB were checked for evidence of tubular or glomerular damage at start, 1 day and 2 days after the administration of a radiocontrast agent. Serum creatinine, BUN, cystatin C and hsCRP levels were also assessed at the same time. Ccr and GFR were calculated according to Cockcroft-Ganh and GFR（ml/min） = 74.835/Cys C^1.333 formulas basing on serum creatinine or cystatin C concentration. Results （1） In control group, comparison with the value before coronary angiography,urinary α1-MG, TRF and mALB or serum cystatin C and hsCRP significantly increased at day 1 after angiography （P〈0.01）. In comparison to the levels at day 1 after angiography, urinary α1-MG, TRF, mALB, serum cystatin C significantly decreased at day 2 after angiography （P〈0.01）, but α1-MG, cystatin C still exceeded the values before coronary angiography, TRF and mALB levels at day 2 after angiography had no significant change compared to baseline（ P 〉0.05）, hsCRP level at day 2 after angiography had no significant change compared to that at day 1 after angiography（P 〉0.05）too. （2） In comparison with the value before coronary angiography in atorvastatin-treated group, the levels of urinary α1-MG, TRF and mALB or serum cystatin C at day 1 and day 2 after angiography had no significant change compared to baseline（P 〉0.05）. Serum hsCRP significantly increased at day 1 after angiography compared to baseline（P 〈0.01）, but it had no significant change compared to day 2 after angiography（ P 〉0.05）. （3） To compare to the atorvastatin-treated group. the values of urinary α1-MG, TRF and mALB or Cvs C and hsCRP significantly increased at day 1 after angiography in control group （ P 〈 0. 01 ）, the values of urinary ctl-MG, cystatin C and hsCRP still significantly increased at day 2 （P 〈 0. 01 ） too, but those of TRF and mALB had no significantly change at day 1 or day 2 after angiography between the two groups （P 〉 0. 05）. There was no significant change in BUN, Cr, Ccr levels before and after angiography between the two groups. Conclusions Low dose contrast induces light renal function damage. Pretreatment with atorvastatin 20 mg/qn for 2 to 3 days could significantly reduce procedural inflammatory reaction, attenuate urinary protein and the effect of degrading GFR in coronarv angiographv natients.