不同剂量阿托伐他汀对老年糖尿病患者冠状动脉介入治疗术后对比剂肾病的影响

Protective effects of different dosage of Atorvastatin on Contrast-Induced Nephropathy in old Db patients underwent coronary artery CTA

目的研究不同剂量阿托伐他汀对老年糖尿病患者冠状动脉(冠脉)介入治疗术后对比剂肾病的影响。方法将80例行冠脉介入检查和治疗的老年糖尿病患者随机分为大剂量组(80 mg/d,n=40)和常规剂量组(20 mg/d,n=40),分别于冠脉介入治疗前2～3 d开始每晚顿服阿托伐他汀80 mg及20 mg。所有患者分别于冠脉介入治疗前1天、检查后第1天、第3天、第5天测定血尿素氮(Bun)、血肌酐(Scr)、尿β2-微球蛋白及尿白蛋白的改变。并根据Cockcroft-Gault公式计算出内生肌酐清除率(Ccr)。结果①小剂量组:与冠脉介入治疗前相比,治疗后第1～3天Scr尿β2-微球蛋白均有显著升高(P<0.01),Ccr显著降低(P<0.01);检查后第5天Scr、Ccr、尿β2-微球蛋白、白蛋白均无显著变化(P>0.05)。②大剂量组:与治疗前比较,治疗后第1～3天Scr、尿β2-微球蛋白均升高(P<0.05),Ccr降低(P<0.05),检查后第5天Scr、Ccr、尿β2-微球蛋白、白蛋白均无显著变化(P>0.05)。③与常规剂量组相比:大剂量组检查后第1～3天Scr、尿β2-微球蛋白、尿白蛋白显著降低(P<0.01),Ccr显著升高(P<0.01);检查后第5天尿β2微球蛋白、尿白蛋白、Scr、Ccr差异均无统计学意义(P>0.05)。两组治疗前后BUN均无明显的变化(P>0.05)。结论阿托伐他汀对老年糖尿病患者冠脉介入治疗术后对比剂肾病有预防作用,并且使用大剂量(80 mg/d)的阿托伐他汀可能对对比剂肾病的发生有更好的预防作用。

【Objective】 To investigate the protective effect of different doses of Atorvastatin on CIN.【Methods】 80 old Db patients who underwent coronary artery angiography with 64-slice spiral computed tomography were randomized to receive high dose of Atorvastatin（80 mg/d,n =40） or small dose of Atorvastatin（20 mg/d,n =40） treatment for 2～3 days before coronary artery angiography with 64-slice spiral computed tomography.After the administration of a radiocontrast agent 1 day,3 days and 5 days,serum creatinine and BUN were also assessed at the same time.【Results】 In control group,comparison with the value before coronary artery angiography with 64-slice spiral computed tomography,Scr and urine-β2 microglobulin significantly increased（P 0.05）.In the test group,comparison with the value before coronary artery angiography with 64-slice spiral computed tomography,Scr and urine-β2 microglobulin significantly increased（P 0.05）.Compared to the control group,the values of Scr and urine-β2 microglobulin significantly reduced（P 0.05）.There was no significant change in BUN levels compared to baseline after angiography in two group（P 〉0.05）.【Conclusion】 Taking high dose of Atorvastatin before angiography with contrast media maybe prevent the contrast-induced nephropathy.