乌司他丁对老年冠心病患者造影剂肾病保护作用的临床研究

Clinical effect of ulinastatin in prevention of contrast induced renal injury in elderly patients with coronary heart disease

目的 探讨乌司他丁对老年冠心病患者造影剂肾病是否具有保护作用.方法 将2007年3月至2008年5月行冠状动脉介入治疗的年龄≥65岁的冠心病患者87例完全随机分为对照组和乌司他丁组.对照组44例常规水化.乌司他丁组43例,在对照组基础上分别于术前4 h予乌司他丁15000 U/kg加0.9%氯化钠注射液稀释至20ml静脉滴注1次,术后第1、2天分别再次静脉滴注乌司他丁1次（10000U/kg加0.9%氯化钠注射液稀释至20 ml）.比较两组造影后48 h及5 d时血尿素氮、肌酐、内生肌酐清除率和尿β2微球蛋白（β2-MG）、尿N2乙酰β2氨基葡萄糖苷酶（NAG）、肾损伤因子（KIM-1）、自由水清除率（CH2O）以及造影剂肾病发生率.结果 两组在应用造影剂后48 h血BUN、Cr及尿β2-MG、NAG、KIM-1、CH2O[对照组分别为（12.8±3.4）mmol/L、（132.3±38.5）μmol/L、（314.2±98.1）μg/L、（25.8±7.2）U/L、（4.29±0.76）μg/L、（-7.3±15.8）ml/h;乌司他丁组分别为（8.4±3.7）mmol/L、（102.3±29.8）μmol/L、（253.4±88.7）μg/L、（18.3±5.6）I/L、（2.12±0.83）μg/L、（-15.9±20.1）ml/h]均较本组造影前[对照组分别为（7.5±2.4）mmol/L、（93.5±19.4）μmol/L、（178.9±50.9）μg/L、（14.8±2.2）U/L、（0.38±0.15）μg/L、（-22.1±22.6）ml/g;乌司他丁组分别为（6.6±2.7）mmol/L、（87.1±15.4）μmol/L、（187.1±67.3）lμg/L、（13.4±3.5）U/L、（-24.0±24.6）ml/h]升高,而内生肌酐清除率下降（P＜0.05）,但乌司他丁组明显低于对照组（P＜0.05）;对照组造影后5 d较48 h有所下降,但未达到造影前水平.而乌司他丁组造影5 d后达到造影前水平.对照组造影剂肾病8例（18.2%）,乌司他丁组3例（6.9%）,两组比较差异有统计学意义（P＜0.05）.结论 乌司他丁对老年冠心病患者造影剂肾病具有一定的预防保护作用.

Objective To investigate the effect of ulinastatin on contrast-induced nephropathyin patients with coronary heart disease. Methods Eighty-seven patients of or above 65 with coronary heart disease from March 2007 to May 2008 were randomly divided into control group and ulinastatin（UTI）group： control group had 44 cases of normal hydration and UTI group had 43 cases. The parameters of renal functions were measured and compared 48hours and 5 days after contrast administration,including serum urea nitrogen and creatinine and creatinine clearance rate and urineβ2-microglobulin and urine N-acety l-β-glucosaminidase （NAG）,Kidney damage factor （KIM-1）,free water clearance （CH2O） and contrast medium nephroma. Results Forty-eight hours after application of contrast agent,serum BUN,Cr and urine β2-MG,NAG,KIM-1,CH2O in the two groups were significantly increased and CrCl declined （P 〈 0.05）,but these indexes in observation group were significantly lower than those in the control group （P 〈 0.05）. Contrast agent nephropathy occurred in 8 patients （18.2%） in control group,while 3 occurred in observation group patients （6.9%）,（P 〈 0.05）. Conclusion Ulinastatin has preventive effect on contrast induced nephropathy in patients with coronary heart disease.