不同剂量阿托伐他汀预防造影剂肾病的研究

STUDY OF DIFFERENT DOSE ATORASTATIN IN PRVWENTION OF CONTRAST INDUCED NEPHROPATHY

目的观察不同剂量阿托伐他汀对冠脉介入治疗患者肾功能的影响。方法将160例择期冠状动脉介入治疗的患者随机分为二组,高剂量组(80例)阿托伐他汀40mg/d和常规剂量组(80例)阿托伐他汀20mg/d。测定介入术前和术后第一、二、三天肾功能,比较二组术前、术后血清肌酐(Scr)和肌酐清除率(Ccr)的变化情况。随访患者术后2周肝功能和肌酶水平。结果二组患者术前Scr和Ccr水平比较差异无统计学意义(P>0.05)。二组患者术后1d、2d Scr水平升高,然后降低。术后3d,高剂量组Scr水平降低并接近恢复术前水平(P>0.05),而常规剂量组Scr水平有降低但未恢复到术前水平(P<0.05)。二组患者术后1d、2d Ccr水平都有降低,然后升高。PCI术后3d,高剂量组Ccr升高并接近恢复术前水平(P>0.05),而常规剂量组未恢复到术前水平(P<0.05)。所有患者中共有17例发生造影剂肾病(CIN),CIN的总发生率为10.62%(17/160),高剂量他汀组CIN发生率与常规剂量组比较差异无统计学意义(8.75%vs12.50%,P>0.05)。所有患者随访2周均未见药物不良反应。结论介入术前40mg/d阿托伐他汀能减轻患者介入术后肾脏损伤程度和促进损伤肾脏的早期恢复。

Objective To observe the effects of different dose atorvastatin on renal function iia patients underwent percutaneous coronary intervention（PCI）. Methods Totally 160 patients undergoing PCI were divided randomly into two groups, high dose group （n = 80）and standard dose group（n = 80）. High dose group preoperatively received atorvastin 40mg/d for 2 days and subsequently received atorvastin 40rag/d; stardard dose group were given atorvastin 20mg/d. The renal function was measured at admission, after PCI day 1, day 2, day 3. Serum creatinine（Scr） and Creatinine clearance rate（Ccr） before and after the procedure were compared between the groups. The monitoring of liver function and creatase levels should be undertaken 2 weeks after PCI. Results The level of Scr and Ccr before PCI was not significantly different between the two groups（P〉0.05）. The level of Scr was significantly increased after PCI day 1, day 2 and then began to decrease in two groups（P〉0.05）. After PCI day 3, the Scr level was significantly decreased to baseline level in high dose group （P〈0.05）, whereas the Scr level was failed to significantly decrease in stardard dose group（P〈0. 05）, and a similar result was found in Ccr. The level of Ccr was significantly decreased after PCI day 1, day 2 and then began to increase in two groups（P〈0.05）. 17 cases of CIN were found in all PCI patients,the incidence of CIN was 10.62% （17/160）. There was no significant difference between the two groups in the incidence of CIN （8.75% vs 12.5% ,P〉0.05）. All patients were followed up for 2 weeks showed no adverse drug reaction. Conclusion Pretreatment with atorvatin （40mg/ d） before PCI can relieve kidney damage and promote the early recovery of renal injury after PCI.