阿托伐他汀强化治疗对急性冠脉综合征患者PCI后肾脏的保护作用探讨

Effect of atorvastatin on renal function in patients with acute coronary syndrome after PCI

目的:探讨阿托伐他汀强化治疗对急性冠状动脉综合征患者冠状动脉介入治疗(PCI)后肾功能保护作用及机制。方法:选择213例急性冠状动脉综合征接受PCI治疗的患者,随机分阿托伐他汀强化治疗组、常规剂量对照组,分别于术前,术后第1、2、7d,术后1月空腹抽血测定血肌酐(Scr)、血超敏C反应蛋白(hs-CRP),尿N-乙酰-B氨基葡萄糖苷酶(NAG)、尿微量白蛋白(UmAlb)。结果:阿托伐他汀强化治疗组CIN发生率明显低于对照组,差异具有统计学意义(P<0.05);PCI术后第1、2d患者Scr,NAG,UmAlb均较术前明显增加,差异具有统计学意义(P<0.05);术后7d逐渐恢复正常,差异无统计学意义(P>0.05);术后1月较术前有明显降低,差异具有统计学意义(P<0.05);PCI术后第1、2d患者hs-CRP较术前明显增加,术后第7天及1月较术前明显减低,差异具有统计学意义(P<0.05);强化治疗组的血清hs-CRP、NAG(U/l)各点水平的整体情况明显低于常规剂量组,差异具有统计学意义(P<0.05)。结论:ACS行PCI术前阿托伐他汀强化治疗能预防造影剂肾病的发生,减低对肾功能的损害。其作用机制可能与减轻炎症反应、改善血管内皮功能等有关。

Objective：To observe effect of atorvastatin on renal function in patients with acute coronary syndrome（ACS）after PCI.Method：A total of 213patients with ACS were random divide into two groups：atorvastatin（40mg）group and control group of atorvastatin（20mg）.Blood and urine samples were collected at baseline,1,2,7day and 1month after PCI.The samples have been detected serum creatinine（Scr）,high sensitivity C-reactive protein（hs-CRP） and Urinary N-acetyl beta-D-Glucosaminidase（NAG）,urinary albumin（UmAlb） levels.Results ： The rate of CIN in atorvastatin（40 mg） group was significantly lower than the control group（P0.05）.The serum levels of Scr,NAG and UmAlb on the first day and the second day were significantly higher than thosepreoperative PCI.The serum levels gradually returned to normal in 7 days.And the serum levels of Scr,NAG,UmAlb in the postoperative PCI 1 month were significantly decreased compared with before operation（P0.05）.The serum level of hs-CRP in the postoperative PCI 1 day,2 day increased significantly（P0.05）,and compared with the preoperative,the lever in postoperative 7 day and 1 month significantly reduced（P0.05）.The serum levers of hs-CRP and NAG in the atorvastatin（40 mg） group during the whole observation period were significantly lower than the control group of atorvastatin（20 mg）（P0.05）.Conclusion ： Contrast induced nephropathy（CIN） can be induced after PCI.Atorvastatin（40mg） can protect renal function,reduce theratio of CIN.Its mechanism may be related to mitigated inflammatory reaction and improved endothelial function.