强化阿托伐他汀治疗对PCI术后肾功能的影响

The effect of intensive atorvastatin treatment on kidney function in patients after percutaneous coronary intervention

目的探讨强化剂量的阿托伐他汀能否减轻经皮冠脉介入术（ PCI）对患者肾功能的影响及减少对比剂致急性肾损伤（ CI-AKI）的发生率。方法将128例接受PCI治疗的患者随机分为2组：强化组（n=64）和对照组（n=64）。强化组术前12~24 h、术后第1天及第2天均口服80 mg阿托伐他汀,对照组术前及术后口服20 mg阿托伐他汀。主要终点事件是CI-AKI的发生率,并观察患者术前24 h和术后24、48、72 h的血清肌酐（ Scr）、胱抑素C、肾小球滤过率（ eG-FR）、尿白蛋白、尿β-2微球蛋白水平。结果强化组3.1%（n=2）的患者发生CI-AKI,对照组为4.7%（n=3）,两组间差异无统计学意义（ P=1.00）；术后两组间Scr、胱抑素C、eGFR、尿白蛋白、尿β-2微球蛋白和肌酸激酶（ CK）差异均无统计学意义。术后3 d两组谷丙转氨酶（ ALT）升高,强化组谷草转氨酶（AST）亦升高（P〈0.05）,但均在正常参考值范围内。结论 PCI术前强化阿托伐他汀治疗与常规剂量比较在减轻肾功能损伤和降低CI-AKI发生率方面差异无统计学意义。

Objective To investigate whether intensive atorvastatin treatment in patients after percutaneous coro-nary intervention （ PCI） could decrease the effect of contrast medium on kidney function and the incidence of con-trast-induced acute kidney injury（ CI-AKI） . Methods A total of 128 patients with PCI were randomly divided into two groups：the enhanced treatment group （n=64） and the control group（n=64）. The enhanced treatment group received 80 mg atorvastatin at 12~24 h before PCI and 24,48 h after PCI. The control group was given 20 mg ator-vastatin respectively before and after PCI. The primary end point was the incidence of CI-AKI. Serum creatinine （Scr）, cystatin C, glomerular filtration rate（eGFR）, urinary albumin and urinary β-2 microglobulin levels were observed at 24 h before PCI and 24, 48, 72 h after PCI. Results In the enhanced treatment group 3. 1 % （n=2） of patients developed CI-AKI versus 4. 7 % （n=3） in the control group, without statistical difference （P=1.00）. There was no significant difference between two groups in postoperative Scr, cystatin C, eGFR, urinary al-bumin, urinary β-2 microglobulin and creatine kinase（CK）. Three days after the operation, alanine aminotrans-ferase （ ALT） elevated in two groups, and aspartate aminotransferase （ AST） increased in the enhanced treatment group （P〈0. 05）, but they were all in the normal range. Conclusion There has been no significant difference in decreasing the incidence of CI-AKI and the damage of contrast medium on renal function between the enhanced treatment group and the control group before PCI.