阿托伐他汀防止造影剂肾损害的临床观察

Clinical observation of atorvastatin on preventing contrast-induced nephropathy in patients with coronary angiography

目的：观察阿托伐他汀在防止造影剂肾损害中的作用。方法：选择行冠脉介入诊疗的病人152例,随机分为阿托伐他汀组（76例）和对照组（76例）,在两组介入诊疗前后12小时内均给予生理盐水1000ml缓慢静滴的基础上,阿托伐他汀组介入诊疗前2～3天每晚服用阿托伐他汀40mg,对照组未服用阿托伐他汀及其他调脂类药物。观察术前、术后血清肌酐（Scr）,内生肌酐清除率（Ccr）,血β2微球蛋白（β2-MG）,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：血β2-微球蛋白（β2-MG）于术后1、3、5天时,阿托伐他汀组显著低于对照组（2.32±0.44）mg/L比（2.74±0.65）mg/L,P=0.008]、[（2.51±0.45）mg/L比（2.75±0.62）mg/L,P=0.011]、[（2.26±0.43）mg/L比（2.58±0.64）mg/L,P=0.026];尿NAG/Cr于术后1、3、5天时,阿托伐他汀组显著低于对照组[（1.21±0.32）U/mmol比（1.48±0.38）U/mmol,P〈0.001]、[（1.32±0.35）U/mmol比（1.42±0.36）U/mmol,P〈0.001]、[（1.06±0.30）U/mmol比（1.32±0.37）U/mmol,P=0.001];Ccr术后1、3天阿托伐他汀组明显高于对照组[（72.71±20.76）ml/min比（66.12±16.25）ml/min,P=0.035]、[（65.02±14.49）ml/min比（57.25±14.34）ml/min,P=0.019]。结论：造影剂可引起肾功能轻度的一过性损害,冠脉介入诊疗前2~3天口服阿托伐他汀,可减轻炎性反应及降低造影剂肾损害的发生。

Objective：To study the efficacy of atorvastatin on preventing contrast-induced nephropathy（CIN）in patients underwent diagnostic and therapeutic coronary intervention. Methods：152 patients who underwent coronary angiography were randomized to receive atorvastatin（40mg/qn,n=76） or no atorvastatin（n=76） treatment in 2 to 3 days before coronary angiography in which Scr,Ccr,bloodβ2-M,urine NAG/Cr and urine osmolality before and after the procedure were compared between two groups.Results： Baseline demographic characteristics and nephropathy risk factors were similar between two groups.Ccr was significantly reduced while bloodβ2-M and urine NAG/Cr were significantly increased in no atorvastatin group（all P0.05）. Blood β2-M in atorvastatin group was significantly lower than that in no atorvastatin group at day 1[（2.32±0.44）mg/L vs （2.74±0.65）mg/L,P=0.008],day 3[（2.51±0.45）mg/L vs （2.75±0.62）mg/L,P=0.011]and day 5[（2.26±0.43）mg/L vs （2.58±0.64）mg/L,P=0.026] post-procedure respectively;urine NAG/Cr in the atorvastatin group was also significantly lower than that in no atorvastatin group at day 1[（1.21±0.32）U/mmol vs（1.48±0.38）U/mmol,P0.001], day 3[（1.32±0.35）U/mmol vs （1.42±0.36）U/mmol,P0.001],and day 5[（1.06±0.30）U/mmol vs （1.32±0.37）U/mmol,P=0.001] post-procedure respectively;Ccr in atorvastatin group was significantly higher than that in nogatorvastatin group at day 1[（72.71±20.76）ml/min vs （66.12±16.25）ml/min,P=0.035],day 3[ （65.02±14.49）ml/minvs （57.25±14.34）ml/min,P=0.019] post-procedure respectively.Conclusion： The use of atorvastatin before angiography is superior than no atotwastatin on attenuating contrast-induced renal dysfunction.