前列腺素E_1对经皮冠脉介入术后造影剂诱导的急性肾损伤的预防

目的探讨前列腺素E1对经皮冠脉介入术(PCI)后造影剂诱导的急性肾损伤(CI-AKI)的预防作用。方法连续入选2012年1～12月在梅县人民医院心内科住院拟行PCI术的130例慢性肾功能不全患者(血清肌≥1.5mg/dL),采用双盲、随机和前瞻性的方法,所有患者分为安慰剂组和3种剂量前列腺素E1(PGE1)治疗组[10、20或40ng/(kg.min)],接触造影剂之前(60±30)min,开始给药并且持续6h。观察不同组间CI-AKI及其他院内主要不良事件的发生率。CI-AKI定义为:冠脉造影术后48～72h内血清肌酐值较基线绝对值升高≥0.5mg/d(L≥44.2μmol/L)或25%。结果在安慰剂组,造影剂给药在第48h时血清肌酐平均升高(0.72±1.15)mg/dL。48h后,各个PGE1治疗组的升高幅度更低;安慰剂组和20ng/(kg.min)PGE1组之前存在显著差异(P=0.01),通过基线调整,把基线血清肌酐用作协变量分析协方差的结果表明,安慰剂组和20、10ng/(kg.min)PGE1组之间也存在显著差异(P=0.037),在3个PGE1给药方案中,20ng/(kg.min)的方案效果最明显。结论 PGE1能够显著减少慢性肾功能不全患者PCI术后CI-AKI的发生率,在预防CI-AKI发生方面具有显著优势。

Objective It remains uncertain whether prostaglandin E1 （PGE1） prevents contrast-induced acute kidney injury （CI-AKI）. Methods We prospectively studied 130 patients with chronic renal insufficiency （serum creatinine ≥ 1.5 mg/dL） undergoing percutaneous coronary intervention （PCI）. Using a double-blind, randomized, prospective technique, patients were assigned to either placebo or one of three PGE1 treatment groups [10, 20, or 40 ng/（kg·min）]. Infusion was started （60±30） minutes before the administration of radio-contrast and was continued for a total of 6 hours. CI-AKI was defined as a relative increase in serum creatinine of ≥ 25%, or an absolute increase of ≥ 0.5 mg/dL（44.2 μmol/L） occurring within 48~72 hours after contrast medium exposure. Results In the placebo group, radio-contrast administration resulted in a mean increase in serum creatinine of （0.72±1.15） mg/dL at 48 hours. This increase was less in each of the PGE1 treatment groups after 48 hours, with a significant difference between placebo and the 20 ng/（kg·min） PGE1 group （P=0.01）.We demonstrated significant differences between the placebo and 20 ng/（kg·min） PGE1 group and between the placebo and 10 ng/（kg·min） PGE1 group （P=0.037）. Conclusion We found that PGE1 reduces the risk of CI-AKI or other clinically relevant outcomes in patients with chronic renal insufficiency undergoing PCI.