冠心病患者择期冠状动脉介入治疗术前口服大剂量阿托伐他汀预防对比剂肾病

Prevention of Contrast-induced Nephropathy Using High-dose Atorvastatin in Patients with Coronary Heart Disease Undergoing Elective Percutaneous Coronary Intervention

目的了解冠心病患者择期冠状动脉介入治疗(percutaneous coronary intervention,PCI)术前服用大剂量阿托伐他汀对血清高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)及肾功能的影响。方法选择冠心病择期冠状动脉造影检查需要PCI治疗的患者173例,随机分为大剂量阿托伐他汀组(AS组,n=76)和常规治疗组(C组,n=97),治疗7天后行PCI术。术前和术后检测血清hs-CRP、血清肌酐(serum creatinine,SCr),计算肾小球滤过率(glo-merular filtration rate,GFR)。结果两组患者术前24h血hs-CRP水平,低于入院时(t=2.413和2.309,P<0.05)和术后48h(t=2.087和2.368,P<0.05);AS组PCI术前24h和术后48h血清hs-CRP均低于C组(t=2.007和2.275,P<0.05)。两组PCI术后SCr较术前升高(t=2.464和2.392,P<0.05),GFR较术前降低(t=2.496和2.573,P<0.05);术后AS组SCr低于C组(t=2.337,P<0.05),GFR高于C组(t=2.145,P<0.05)。AS组对比剂肾病(contrast-induced nephropathy,CIN)发生率低于C组(6.58%vs16.49%,χ2=3.93,P<0.05)。结论冠心病择期PCI患者术前服用大剂量阿托伐他汀对CIN可能有良好的预防作用,机制可能与显著抑制炎症反应有关。

Objective To investigate the effect of high-dose atorvastatin on serum high-sensitivity C-reactive protein（hs-CRP） and renal function in patients with coronary heart disease（CHD） undergoing elective percutaneous coronary intervention（PCI）.Methods Among 237 CHD patients undergoing elective coronary angiography,173 cases undergoing PCI were randomly divided into high-dose atorvastatin group（group AS,n=76） and conventional treatment group（group C,n=97）.They were treated using drugs for 7 days before PCI.Preoperative and postoperative serum hs-CRP,serum creatinine（SCr） were detected and glomerular filtration rate（GFR） was calculated.Results Serum hs-CRP at 24 hours pre-PCI was lower than the level at admission（t=2.413,2.309,P〈0.05） and at 48 hours post-PCI（t=2.087,2.368,P〈0.05） in the two groups.Serum hs-CRP at 24 hours pre-PCI and 48 hours post-PCI were lower in group AS than in group C（t=2.007,2.275,P〈0.05）.SCr levels were increased and GFR levels were decreased in two groups after PCI（t=2.464,2.392,P〈0.05）.SCr level was lower（t=2.337,P〈0.05） and GFR level was higher（t=2.145,P〈0.05） in group AS than group C.The incidence of contrast-induced nephropathy（CIN） was lower in group AS than that in group C（6.58% vs 16.49%,χ^2=3.93,P〈0.05）.Conclusion High-dose atorvastatin may be effective in protecting CHD patients undergoing PCI from CIN.The underlying mechanism may relate with the significant inhibition on the inflammatory response.