前列地尔对合并糖尿病的冠心病患者介入治疗中造影剂肾病的预防作用研究

The Preventive Effect of Alprostadil on Contrast Nephropathy among the Patients with Coronary Artery Disease Complicated with Diabetes in the Interventional Therapy

目的探讨前列地尔对合并糖尿病的冠心病患者介入治疗中造影剂肾病的预防作用。方法选取我院2012年1月—2013年7月收治的冠心病合并糖尿病且拟行介入治疗的患者100例,采用单纯随机分组方法分为观察组50例与对照组50例。对照组患者使用水化疗法预防造影剂肾病,观察组患者增加使用前列地尔,比较两组患者的造影剂肾病发生率,造影前后肾功能、血管内皮功能的变化以及预后情况。结果 (1)观察组和对照组分别有1例和8例患者发生造影剂肾病,发生率分别为2.00%和16.00%,两组比较差异有统计学意义(P<0.05)。(2)造影前,两组患者血尿素氮、尿β2微球蛋白、血清肌酐水平间差异均无统计学意义(P>0.05);造影后72 h时,观察组患者血尿素氮和尿β2微球蛋白水平与对照组比较,差异均有统计学意义(P<0.05);造影后72 h,两组患者血尿素和尿β2微球蛋白水平与造影前比较,差异均有统计学意义(P<0.05);造影后72 h后,对照组患者的血清肌酐水平与造影前比较,差异有统计学意义(P<0.05)。(3)造影前,两组患者一氧化氮、一氧化氮合成酶和内皮素1水平比较,差异无统计学意义(P>0.05);造影后72 h,观察组患者一氧化氮、一氧化氮合成酶和内皮素1水平与对照组比较,差异均有统计学意义(P<0.05);造影后72 h,两组患者一氧化氮、一氧化氮合成酶和内皮素1水平与造影前比较,差异均有统计学意义(P<0.05)。(4)对照组预后不良共13例(26.0%),观察组预后不良共4例(8.0%),两组间差异有统计学意义(P<0.05)。结论前列地尔在合并有糖尿病的冠心病介入治疗患者中起到良好的预防造影剂肾病的作用,其可保护患者肾功能和血管内皮功能,改善患者预后。

Objective To explore the preventive effect of alprostadil in the interventional therapy on contrast nephrop-athy among the patients with coronary artery disease complicated with diabetes. Methods 100 patients with diabetes and coronary artery disease who were admitted in our hospital from January,2012 to July,2013 and scheduled for interventional therapy were randomly divided into observe group（50）,receiving additional alprostadil and the control group（50）,receiving hydration therapy. The incidence of contrast nephropathy rate,change of vascular endothelium and renal function before and after angiogra-phy,and prognosis between the two groups were compared. Results （1）one case in observe group and eight cases in control group suffered contrast nephropathy and the incidence was 2. 00% and16. 00% respectively,with significant difference（ P 〈0. 05）;（2）Before angiography,no significant difference of blood urea,Urine β2 - microglobulin and serum creatinine between the two groups was found;72h after angiography,the difference of blood urea and Urineβ2 - microglobulin was significant be-tween the two groups and from that before angiography（P 〈 0. 05）;the difference of serum creatinine in control group was signif-icant compared with that before angiography（P 〈 0. 05）. （3）The difference of nitric oxide,nitric oxide synthase and endothe-lin 1 between the two groups was not significant（P 〉 0. 05）;72h after angiography,the difference was significant between the two groups and compared with that after angiography（ P 〈 0. 05）. （4）13（26. 0% ） and in control 4（8. 0% ） had poor prognosis,with significant difference（P 〈 0. 05）. Conclusion Alprostadil in the interventional therapy can have a satisfactory effect on the prevention of contrast nephropathy among the patients with diabetes and coronary artery disease and on the protection of vascular endothelium and renal function,with a higher prognostic level.