急诊经皮冠状动脉介入术前短期、强化阿托伐他汀预防对比剂肾病的研究

Short-term high-dose atorvastatin pretreatment to prevent contrast-induced nephropathy in patients undergoing emergency percutaneous coronary intervention

目的探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术前早期、强化给予阿托伐他汀对对比剂肾病(CIN)的预防作用。方法选择行急诊PCI的STEMI患者120例,随机分为常规他汀治疗组(对照组,n=60)和强化他汀治疗组(研究组,n=60)。两组患者分别于急诊PCI术前开始口服阿托伐他汀20mg/d或60mg/d,连续使用7d,之后以20mg/d维持治疗。观察两组患者术前、术后1、2、3、5、7d血清肌酐(Scr)、估算肾小球滤过率(eGFR)变化情况。CIN定义为:使用对比剂后3d内SCr较基础水平升高≥25%,或绝对值升高≥0.5mg/dl。结果 (1)对照组与研究组Scr、eGFR水平在术前、术后各时间点之间比较均无统计学差异(P>0.05)。两组Scr均在PCI术后第2天较术前升高(P<0.05),第3天达峰值,第7天降至正常。两组eGFR在PCI术后第1天均较术前降低(P<0.05),第2天达谷值;研究组eGFR在第5天恢复至正常,而对照组在第7天恢复至正常。(2)对照组和研究组CIN发生率之间比较无统计学差异(6.7%vs.3.3%,P=0.675)。亚组分析显示,基础肾功能正常的患者无CIN发生;对照组和研究组基础肾功能不全的患者CIN发病率分别为23.5%和10%,但二者比较无统计学差异(P=0.383)。结论对于STEMI患者,在标准水化治疗的基础上,急诊PCI术前短期、强化给予阿托伐他汀可能不能降低CIN的发生风险。

Objective To evaluate whether short-term high-dose atorvastatin administered before emergency percutaneous coronary intervention （PCI） could reduce the incidence of contrast-induced nephropathy （CIN） in patients with acute ST-segment elevation myocardial infarction （STEMI）.Methods 120 patients with STEMI undergoing emergency PCI randomly received either atorvastatin 60 mg （study group,n =60） or 20 mg （control group,n =60） before and 7 days after intervention.All patients had long-term atorvastatin treatment thereafter （20mg/d）.Serum creatinine （Scr） levels and estimated glomerular filtration rate （eGFR） were measured before and at 1,2,3,5 and7 d after PCI.CIN was defined as an increase in the Scr values of ≥25％ or ≥0.5 mg/dl from the baseline within 3 days after PCI.Results （1） There were no significant differences in the levels of Scr and eGFR between the two groups at all time points （P ＞ 0.05）.The level of Scr in the two groups significantly increased 2 days after PCI （P ＜ 0.05） ; Scr peaked 3 days after PCI,and decreased to the baseline level 7 days after PCI.The level of eGFR in the two groups significantly decreased 1 day after PCI （P ＜ 0.05） and eGFR fell to its lowest level 2 days after PCI.eGFR increased to the baseline level 5 days after PCI in the study group and 7 days after PCI in the control group.（2）There was no significant difference in the incidence of CIN between the control group and study group （6.7％ vs.3.3％,P =0.675）.In a subgroup analysis,there was no CIN occurred in patients with normal renal function.In the patients with pre-existing renal insufficiency,23.5％ of those in the study group developed CIN versus 10.0％ of those in the control group （P =0.383）.Conclusions A short-term administration of high doses of atorvastatin before contrast exposure,in addition to standard intravenous hydration,may not be able to decrease CIN occurrence in patients with acute STEMI undergoing emergency PCI.