强化阿托伐他汀对接受PCI治疗的NSTE-ACS患者CIN的干预作用

Efficacy of High Dose Atorvastatin on Preventing Contrast-induced Nephropathy in Patients with NSTE-ACS Undergoing Percutaneous Coronary Intervention

目的:观察不同剂量阿托伐他汀对接受冠状动脉介入治疗(PCI)的非ST段抬高急性冠脉综合征(NSTE-ACS)患者造影剂肾病(CIN)的影响。方法:239例NSTE-ACS患者根据是否并发全身炎症反应综合征(SIRS)分为SIRS组(A组,n=68)和非SIRS对照组(B组,n=171);再根据治疗情况将A组分为强化他汀治疗SIRS组(A1组,n=34)和常规他汀治疗SIRS组(A2组,n=34),将B组分为强化他汀治疗非SIRS对照组(B1组,n=86)和常规他汀治疗非SIRS对照组(B2组,n=85)。观察4组患者PCI术前及术后3天超敏C反应蛋白(hs-CRP)、白介素6(IL-6)、中性粒细胞明胶酶脂质运载蛋白(NGAL)水平和术后3天CIN发生率。结果:术前,A1、A2组hs-CRP及IL-6分别高于B1、B2组(P<0.01);术后3天,A2组hs-CRP、IL-6和NGAL均高于A1组(P<0.01或P<0.05);B2组IL-6高于B1组(P<0.05)。术后3天,4组患者hs-CRP及IL-6较术前降低(P<0.05或P<0.01),NGAL较术前升高(P<0.01)。术后3天,A2组CIN发生率高于A1组和B2组(P<0.05)。结论:强化阿托伐他汀治疗可以降低NSTE-ACS患者PCI术后体内炎症反应,减少CIN发生。

Objective: To observe the efficacy of different dosage atorvastatin on preventing contrast-induced nephropathy in patients with NSTE-ACS undergoing percutaneous coronary intervention. Method: A total of 239 patients with NSTE-ACS were assigned to two groups according to systemic inflammatory response syndrome: SIRS group (group A,n=68) and control group (group B,n=171).Two groups were assigned randomly into A1: high dose atorvastatin with SIRS group; A2: normal dose atorvastatin with SIRS group; B1: high dose atorvastatin with control group; B2: normal dose atorvastatin with control group. The hs-CRP, IL-6, NGAL in 4 groups were observed at pre-stenting and 3 days after PCI. Moreover, The incidence rate of contrast-induced nephropathy was monitored. Results: At pre-stenting, the hs-CRP and IL6 in group A1 and A2 were significantly higher than group B1 and B2 (P<0.01). At 3 days after PCI, the hs-CRP and IL-6 in group A2 were higher than group A1 (P<0.05), the IL-6 in group B2 was higher than group B1 (P<0.05). At 3 days after PCI, the hs-CRP and IL-6 in 4 groups were lower than prestenting (P<0.05). The NGAL in 4 groups were all higher than prestenting (P<0.01). The NGAL in group A2 was higher than group A1 (P<0.05). The accidence rate of contrast-induced nephropathy in group A2 was higher than group A1 and B2(P<0.05). Conclusion: The inflammatory response is an influential factor of contrastinduced nephropathy in patients with NSTE-ACS undergoing percutaneous coronary intervention. High dose atorvastatin can reduce the accidence rate of contrastinduced nephropathy.