大剂量阿托伐他汀对急诊冠状动脉介入治疗患者对比剂肾病的影响

Effects of high-dose atorvastatin on preventing contrast-induced nephropathy in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

目的探讨单次大剂量阿托伐他汀(80 mg)对急性心肌梗死患者直接经皮冠状动脉介入治疗后对比剂肾病(contrast induced nephropathy,CIN)的影响。方法 121例行直接经皮冠状动脉介入治疗的急性ST段抬高心肌梗死患者按数字表法随机分入阿托伐他汀组(60例)和对照组(61例)。阿托伐他汀组在入院后立即给予阿托伐他汀80 mg口服,对照组术前不给予他汀类药物治疗。所有患者术后均给予阿托伐他汀20 mg/d长期服用。术前及术后3天连续监测血清肌酐(serum creatinine,Scr)、血浆胱抑素C(cystatin C,Cys C)、超敏C反应蛋白浓度。根据Cockcroft-Gault公式计算内生肌酐清除率(creatinine clearance rate,Ccr)。结果 121例患者中21例发生CIN,CIN发生率为17.4%,阿托伐他汀组CIN发生率低于对照组,但差异无统计学意义(13.3%vs.21.3%,P>0.05)。阿托伐他汀组术后Cys C峰值较对照组明显降低,差异有统计学意义[(0.94±0.33)mg/L vs.(1.06±0.30)mg/L,P<0.05];术后Scr、Cys C较基线增高的幅度以及术后Ccr较基线降低的幅度均显著低于对照组,差异有统计学意义[(8.2±10.8)μmol/L vs.(14.6±12.9)μmol/L,P<0.01;(0.07±0.04)mg/L vs.(0.18±0.07)mg/L,P<0.01;(6.1±3.7)mL/min vs.(11.2±5.1)mL/min,P<0.01]。阿托伐他汀组术后高敏C反应蛋白峰值及较基线增高的幅度均明显低于对照组,差异有统计学意义[(17.2±6.8)mg/dL vs.(24.3±10.3)mg/dL,P<0.05;(7.3±5.7)mg/dL vs.(14.1±7.5)mg/dL,P<0.01]。结论急性心肌梗死患者直接经皮冠状动脉介入治疗前大剂量阿托伐他汀的预处理可以抑制炎症反应,减轻肾损害,对预防CIN可能有益。

Objectives To investigate the effect of pretreatment with single high-dose atorvastatin on prevention of contrast-induced nephropathy （CIN） in patients with acute myocardial infarction （AMI） who underwent primary percutaneous coronary intervention （PCI）. Methods A total of 121 patients with ST-segment elevation AMI undergoing primary PCI were randomly assigned to atorvastatin group （n=60） and control group （n=61）. In atorvastatin group, atorvastatin （80 rag） were orally administered to patients after admission immediately. In control group, no statin treatment was performed before intervention. All the patients received atorvastatin 20 mg/d after PCI for a long time. The concentrations of serum creatinine （Scr）, cystation C （Cys C） and high sensitivity C-reactive protein （hsCRP） were measured before and after PC[ for 3 days. Creatinine clearance rate （Ccr） was calculated according to Cockcroft-Gauh formula. Results CIN occurred in 21 （17.4%） of the 121 patients. The incidence rate of CIN in atorvastatin group was lower compared with that in control group without significant difference （13.3% vs. 21.3%, P〉 0.05 ）. The post-procedural mean peak of Cys C was significantly lower in atorvastatin group than that in control group [ （0.94±0.33） mg/L vs. （1.06±0.30） mg/L, P〈0.05 ]. The post-procedural increasing Scr, Cys C and decreasing Ccr from baseline in atorvastatin group were significantly lower than those in control group [ （8.2± 10.8 ） μmol/L vs. （ 14.6± 12.9） μmol/L,P〈0.01; （0.07±0.04） mg/Lvs. （0.18±0.07） mg/L, P〈0.01; （6.1±3.7） mL/minvs. （11.2±5.1） mL!min, P〈0.01 ]. After the procedure, the mean peak of hsCRP and increasing hsCRP from baseline decreased significantly in atorvastatin group compared with those in control group [ （17.2~6.8） mg/dL vs. （24.3±10.3） mg/dL, P〈0.05 ; （7.3~5.7） mg/dL vs. （14.1~7.5） mg/dL, P〈0.01 ]. Conclusions Pretreatment with high-dose atorvastatin can significantly inhibit inflammatory reaction, reduce acute kidney injury after primary PCI in patients with AMI. It might be effective in protecting patients undergoing primary PCI from CIN.