摘要
目的:探讨不同剂量阿托伐他汀干预对高水平高敏C反应蛋白(hs—CRP)患者经皮冠状动脉介入术(PCI)后发生对比剂肾病(CIN)的影响。方法:人选2011-01至2012—06在我院心内科住院拟行PCI治疗的患者700例,分为强化治疗组(226例)和常规治疗组(474例)。伞部患者入院前3个月内未服用他汀类药物,hs—CRP水平均在3mg/L水平以L,PCI术前24h~术后72h均使用阿托伐他汀治疗。在常规水化治疗基础上,强化治疗组患者给予阿托伐他汀40mg/d,常规治疗组给予阿托伐他汀20mg/d,记录PCI术前及术后48~72h血清肌酐(Scr),尿素氮(BUN)等指标。CIN的诊断标准为:排除其他原因引起的急性肾功能损害,接触对比剂后48~72h内血清肌酐浓度升高〉0.5mg/dl(44.2μmol/L)或者较原基础值升高25%以上。观察入选患者CIN的发生率、危险因素及院内临床不良事件(包括死亡、心肌梗死、心力衰竭及透析等)。结果:100例(14.2%)患者发生了对比剂肾病,强化治疗组对比剂肾病发生率低于常规治疗组(13.3%VS14.8%,x2=0.278,P=O.597),但两组间差异无统计学意义。两组患者死亡率(0.4%比0%,x2=0.96,P=O.327)、需要肾脏替代治疗(RRT,0.9%比0.4%,x2=O.834,P=O.770)、再发心肌梗死(1.1%比0.4%,x2=0.682,P=O.409)、急性心力衰竭(2.7%比2.1%,x20.197,P=0.658)等院内临床不良事件发生率间差异均无统计学意义。对CIN潜在的危险因素进行单因素回归分析,将有统计学差异的变量:强化他汀、术前hs—CRP、年龄〉75岁、糖尿病、基础估计肾小球滤过率(eGFR)〈60ml(min·1.73m2)、急诊PCI、同手术期低血压纳入多因素Logistic回归模型,结果显示术前hs—CRP、急诊PCI、围手术期低血压仍与CIN显著独立相关(分别是OR=1.009,95%CI1.003—1.016,P=O.005;OR=2.133,95%CI 1.532—4.178,P=O.037;OR=3.176,95%CI1.416~7.126,P=O.005)。结论:强化阿托伐他汀治疗对高水平hs—CRP患者PCI后CIN的发生可能无预防作用。
Objective: To explore the impact for different dose ofatorvastatin medication on contrast-induced nephropathy (CIN) in patients with high level of hs-CRP after percutaneous coronary intervention (PCI). Methods: A total of 700 patients who received PCI in our hospital from 2011-01 to 2012-06 were studied. The patients were divided into 2 groups, Intensive group, n=226, the patients received atorvastatin 40 mg/day at 24 h before to 72 h after PCI, and Routine group, n=474, the patients received atorvastatin 20 rag/day at 24 h before to 72 h after PCI. All patients had pre-operative hs-CRP 〉 3 mg/L and without atorvastatin medication at 3 months before PCI. The serum levels of creatinine (Scr) and urea nitrogen (BUN) were examined at before and 48 h, 72 h after PCI. CIN was defined by elevated Scr 〉 0.5 mg/dl or 25% within 48-72 h after contrast exposure. The CIN occurrence with MACE were compared between 2 groups. Results: CIN occurred in 100/700 (14.3%) patients, the Intensive group and Routine group were similar (13.3% vs 14.8%, Z2=0.278, P=0.597), and the mortality (0.4% vs 0%, Z2=0. 96, P=0. 327), the incidence for requiring renal- replacement therapy (0.9% vs 0.4%, Z2=0.834, P=0.770), re-myocardial infarction (1.1% vs.0.4%, ;~2=0. 682, P=0.409), acute heart failure (2.7% vs.2.1%, X2=0.197, P=0. 658) were similar between 2 groups. Multivariate logistic regression analysis showed that hs-CRP (OR=1.009, 95% CI 1.003-1.016, P=0.005), primary PCI (OR=2.133, 95% CI 1.532-4.178, P=0.037) and peri-operative hypotension (OR=3.176, 95%CI 1.416-7.126, P=0.005) were the independent risk factors for CIN. Conclusion: The intensive atorvastatin medication could not prevent CIN in patients with high level of hs-CRP after PCI.
出处
《中国循环杂志》
CSCD
北大核心
2014年第4期247-251,共5页
Chinese Circulation Journal
关键词
阿托伐他汀
高敏C反应蛋白
造影剂
肾病
血管成形术
经皮冠状动脉介入治疗
Atorvastatin
High sensitivity C-reactive protein
Contrast media
Nephrosis
Angioplasty
Percutaneous coronary intervention