大剂量阿托伐他汀联合水化对老年急诊PCI术后造影剂肾病的保护作用

Effect of high dose atorvastatin combined with hydratin in preventing contrast induced nephropathy in elderly patients underwent primary PCI

目的探讨阿托伐他汀(80 mg)联合水化对老年(年龄≥60岁)急诊冠状动脉介入术(PCI)术后造影剂肾病的保护作用。方法 92例患者随机分为大剂量强化治疗组、常规剂量治疗组、空白对照组,3组患者在水化治疗的基础上,大剂量强化治疗组:入院后口服阿托伐他汀80 mg,急诊PCI术后3 d内口服阿托伐他汀40 mg.d-1;常规剂量治疗组:入院后口服阿托伐他汀20 mg,急诊PCI术后3 d内口服阿托伐他汀20 mg.d-1;空白对照组:术前未给予他汀类药物。分别测定3组患者术后24,72 h的血肌酐(Scr)、尿素氮(BUN)、内生肌酐清除率(Ccr)以及造影剂肾病的发生率。结果急诊PCI术后24 h与PCI术前相比,大剂量强化治疗组BUN,Scr的增加值较常规剂量治疗组小,差异有统计学意义(P<0.05)。急诊PCI术后72 h与PCI术前相比,大剂量强化治疗组BUN,Scr的增加值以及Ccr的下降值明显低于常规剂量治疗组(P<0.05)。结论大剂量阿托伐他汀联合水化对老年急诊PCI术后造影剂肾病具有一定的保护作用。

Objective To investigate protection effect of high dose sta tions（80 rag） combined with hydration in elderly patients on contrast in duced nephropathy after primary percutaneous coronary intervention （PCI）. Methods Before primary PCI,92 case with acute myocardial infarction were divided into three groups：high dose atorvastatin group, regular dose atorvastatin group and blank control group. On the basis of the hydration therapy, the patients of high dose atorvastatin group re ceived atorvastatin 80 mg orally instantly before primary PCI and 40 mg once a day after primary PCI procedure for three days. The patients of regular dose atorvastatin groups received atorvastatin 20 mg orally instant ly before primary PCI and once a day after primary PCI procedure for three days . Then BUN, Scr, Ccr and incident rate of CIN were measured and compared 24,72 h after primary PCI between groups. Results In creased value of BUN and Scr in high dose group at 24 h post primary PCI were significantly lower than regular group when compare with before primary PCI （P〈0. 05）. Increased value of BUN and Scr in high dose group at 72 h were significantly lower than regular group either when compare with before primary PCI （ P 〈 0.05 ）. Conclusion High dose atorvastatin combined with hydration can he of some preventive and pro tective value to CIN for the elderly patients after primary PCI.