阿托伐他汀联合普罗布考对老年冠心病患者对比剂急性肾损伤和血尿酸的影响

The effect of atorvastatin combined with probucol on contrast-induced acute kidney injury and serum uric acid in elderly patients

目的观察术前联用不同剂量阿托伐他汀与普罗布考对老年冠心病患者对比剂急性肾损伤（CIAKI）和血尿酸的影响。方法接受择期冠状动脉造影（CAG）或经皮冠状动脉支架植入术（PCI）的老年冠心病患者121例，随机分为标准联合剂量治疗（标准联合）组35例：阿托伐他汀每晚顿服20mg及普罗布考250mg，3次／d，术前无强化；强化联合剂量治疗（强化联合）组41例：阿托伐他汀每晚顿服40mg及普罗布考250mg，3次／d，术前2h顿服阿托伐他汀40mg普罗布考500mg；强化剂量治疗（强化）组45例：阿托伐他汀每晚顿服40mg，术前2h顿服阿托伐他汀40mg。所有患者术前、术后24h抽取静脉血检测血尿素、肌酐、尿酸，肾脏病膳食改良试验（MDRD）方法估算肾小球滤过率。留取静脉血和术前清晨第一次中段尿液及术后24h尿液测定中性粒细胞明胶酶相关脂质运载蛋白（NGAL）浓度。结果（1）与术前比较，强化联合和强化组术后血尿素均下降，（5．6±1．4）mmol／L与（4．7±0．9）mmol／L、（5．3±1．2）mmol／L与（4．8±1．2）mmol／L（P〈0．01，P〈0．05），血肌酐和肾小球滤过率变化差异无统计学意义；标准联合组术后肾小球滤过率下降，（76．2士14．3）ml·min-1·1．73m-2与（71．9±17．9）ml·min-1·1．73m-2（P〈0．05）；术后只有强化联合组血尿酸下降（P〈0．01）。（2）标准联合组术后尿NGAL升高，其尿NGAL变化值较其他两组高（均P〈0．01）。结论术前联用阿托伐他汀40mg和普罗布考250mg，3次／d，或单用阿托伐他汀40mg，均可改善CIAKI，只有强化联合方式在短期内可降低血尿酸。

Objective To observe the effect of different doses of atorvastatin combined with probucol on contrast-induced acute kidney injury （CIAKI） and serum uric acid in elderly patients. Methods Totally 121 cases admitted for coronary angioplasty were randomly divided into three groups. In standard combining treatment group （n：35）, atorvastatin 20 mg qn and probucol 0.25 g, tid were given with no loading dose intake before angioplasty. In intensively combined treatment group （n：41）, atorvastatin 40rag qn and probucol 0.25 g,tid were given with a loading dose of atorvastatin 40 mg and probucol 0.5 g at 2 hours before angioplasty. In intensive atorvastatin therapy group（n： 45）, atorvastatin 40 mg qn were given, with a loading dose of atorvastatin 40 mg 2 hours before angioplasty. All patients were then evaluated 24 hours before and after angioplasty procedure, and their blood urea nitrogen （ BUN）, serum creatinine （Scr）, serum uric acid （SUA）, estimated glomerular filtration rate （eGFR） by modified diet in renal disease study （MDRD） method were tested. The serum and urine at 24 hours before and after operation were collected. Neutrophil gelatinase associated lipocalin （NGAL） were determinated by enzyme linked immunosorbnent assay （ELISA） method. Results After operation, eGFR was decreased in standard combining treatment group ^（76.2^14.3） ml＂ min 1 . 1.73 m-2 vs. （71.9i-17.9） ml ~ min 1 . 1.73 m-2, P^0.053, while Scr, eGFR and uNGAL showed no changes in intensively combining treatment group and intensive atorvastatin therapy group （P〉0.05） ; BUN in the two groups was decreased （5.6± 1.4） mmol/L vs. （4. 7±0. 9） retool/L, （5.3±1.2） mmol/L vs. （4.8±1.2） mmol/L, P〈0.01, P〈 0. 051. SUA was reduced in intensively combining treatment group （P〈 0.05）. uNGAL was increased in standard combining treatment group （P〈0.05）. Conclusions For elderly patients, intensive atorvastatin therapy and combining intensive treatment can both improve CIAKI. Only combination and intensive treatment benefit for decrease of uric acid.