高剂量阿托伐他汀预防对比剂肾损害的临床观察

Clinical observation of high dose atorvastatin in preventing contrast induced kidney injury

目的探讨高剂量阿托伐他汀能否预防冠状动脉介入性诊断及治疗术后的急性肾损害。方法将120例行冠状动脉介入诊断与治疗患者随机分为高剂量组和低剂量组各60例。在全部采用水化治疗和给予阿托伐他汀10mg/d的基础上,高剂量组术前12～24h阿托伐他汀加量至80mg口服。观察造影前及造影后1、3、5d血清肌酐(Scr)、内生肌酐清除率(Ccr)、血β2-微球蛋白、尿N-乙酰-β-D-葡萄糖酸苷酶(NAG)/尿肌酐(Cr)、尿渗透压的改变情况。结果造影后1、3、5d,高剂量组Ccr水平高于低剂量组,血β2-微球蛋白及尿NAG/Cr水平低于低剂量组,差异均有统计学意义(P<0.05);2组造影前后Scr、尿渗透压差异无统计学意义(P>0.05)。2组CIN发生率差异无统计学意义(P>0.05)。结论血管造影前使用高剂最(80mg)的阿托伐他汀可能有助于减少对比剂肾病的发生。

Objective To explore whether the high dose atorvastatin can prevent the acute kidney damage after coronary interventional diagnosis and treatment. Methods 120 cases of patients, underwent coronary interventional diagnosis and treatment, were randomly divided into high dose group and low dose group, each of 60 cases. All patients received hydrated therapy and atorvastatin 10 mg/d. High dose group received additional atorvastatin 80mg at 12 - 24 hours before procedure. The serum creatinine（ Scr）, creatinine clearance rate （ Ccr）, blood β2-microglobulin, urinary N-Acetyl-D-glucose acid glycosidase （NAG）/urine creatinine（ Cr）,and urine osmolality changes before and 1,3,5 days after the procedure were compared between two groups. Results 1,3,5 days after the procedure, the Ccr level of high dose group was higher than that of low dose group,the blood β2-microglobulin and uric NAG/Cr level were lower than those in low dose group（P 〈0.05 ）. The difference of Scr, urine osmolality before and after the procedure of two groups was not statistically significance（ P 〉 0.05 ）. The CIN incidence of twe groups was no significant difference （P 〉 0.05）. Conclusion High dose atorvastatin use before angiography is superior than low dose atorvastatin on attenuating contrast induced renal dysfunction.