脂质体携载前列腺素E1对冠心病合并糖尿病患者发生造影剂肾病的预防作用

Preventive effect of prostaglandin E1 on contrast medium-induced nephropathy in patients with coronary disease combined with diabetes meilitus

目的探讨脂质体携载前列腺素E1（PGE1）对冠心病合并糖尿病的患者发生造影剂肾病的预防作用。方法选取行冠脉造影或介入治疗的合并糖尿病的冠心病患者198例，随机分为对照组和PGE1组。PGE1组在常规治疗的基础上予PGE120μg＋生理盐水20ml静脉注射，1次／d，共10d，比较两组造影前、造影后48h、5d血肌酐（Scr）、尿素（BUN）、胱抑素C（CysC）水平及造影剂肾病发生率等。结果造影后48h、5dScr、BUN、CysC等在PGE1组分别为（113．92±54．89）μmmol／L、（7．85±4．05）mmol／L、（1．38±0．34）mg／L和（86．72±35．26）μmmol／L、（6．61±3．09）mmol／L、（1．29±0．29）mg／L优于对照组（129．22±50．18）μmmol／L、（9．28±3．95）mmol／L、（1.56±0．23）mg／L和（109．83±31．76）μmmol／L、（8．07±3．11）mmol／L、（1．37±0．21）mg／L，差异有统计学意义（均P〈0．05）。经直线相关分析，造影剂剂量与BUN、Scr呈显著正相关（r=0．74，P〈0．05；r=0．82，P〈0．01）。结论PGE1对冠心病合并糖尿病的患者发生造影剂肾病有预防作用。

Objective To study whether prostaglandin E1 （LipoPGE1） could prevent contrast mediuminduced nephropathy （CIN） in patients with coronary heart disease （CHD） plus diabetes mellitus type 2 （DM）. Methods Total 198 CHD patients with DM received coronary angiography （CAG） or PCI were randomly divided into PGE1 group and control group. All patients received routine treatment, and the PGE1 group also received 20 ml normal saline and 20 μg PGE1 （intravenous injection , 1 time/d） for 10 days. The rate of CIN and the level of serum urea nitrogen （BUN）, creatinine （Scr）, cystatin C （Cys C） were measured before and 48 hours and 5 days after contrast medium administration. Results The level of Scr, BUN and Cys C were lower in PGE1 group [（113.92±54.89）μmmol/L、（7.85±4.05）mmol/L、（1.38±0.34）mg/L] for 48 hours and [（86.72±35.26）μmmol/L、（6.61±3.09）mmol/L、（1.29±0.29）mg/L] for 5 days than in control group [129.22±50.18）μmmol/L、（9.28±3.95）mmol/L、（1.56±0.23）mg/L] for 48 hours and [（109.83±31.76）μmmol/L、（8.07±3.11）mmol/L、（1.37±0.21）mg/L] for 5 days （all P〈0. 05）. The dose of contrast-medium was positively correlated with the level of Scr and BUN （r=0. 74,P〈0. 05 and r =0.82,P〈0.01, respectively）. The patientsr renal function in the PGE1 group was better than in control group after contrast-medium administration （P 〈0.05） . BUN and Scr were positively correlated with the volume of contrast-medium （r= 0.74, P〈0.05, r=0.82, P〈0.01）. Conclusions PGE1 may prevent contrast medium-induced nephropathy in patients with CHD combined with DM.