不同剂量阿托伐他汀对经皮冠状动脉介入术后对比剂急性肾损伤的影响

The Effect of Different Atorvastatin Doses on Contrast Induced Acute Kidney Injury after Percutaneous Coronary Intervention

目的观察经皮冠状动脉介入术(PCI)前使用不同剂量阿托伐他汀对对比剂诱导的急性肾损伤的影响。方法入选拟行冠状动脉造影检查及拟行PCI术的患者106例,随机分成2组:20 mg阿托伐他汀组及40 mg阿托伐他汀组;入院24 h内完成常规化验检查、心脏彩色超声检查及肾脏血管超声检查,术后48 h复查肾功能。所有患者手术前当日清晨、术后2 h及术后48 h均留取约5 mL中段尿,用胶乳增强免疫透射比浊法统一测定中性粒细胞明胶酶相关脂质运载蛋白(NGAL)。结果 PCI术后,40 mg阿托伐他汀组与20 mg阿托伐他汀组比较,血清肌酐(77.44±23.14 mmol/L比94.24±36.14 mmol/L,P=0.014)降低,尿酸(313.05±110.84μmol/L比354.00±100.66μmol/L,P=0.060)降低,肾小球滤过率估计值(92.24±24.74比75.31±31.34,P=0.009)增高;PCI术后,40 mg阿托伐他汀组与20 mg阿托伐他汀组比较,2 h NGAL(33.13±20.44μg/L比50.67±46.95μg/L,P=0.013)、48 h NGAL(27.56±18.64μg/L比58.38±56.81μg/L,P=0.001)减低;应用对比剂后,20 mg阿托伐他汀组发生对比剂急性肾损伤11例,发生率为20.75%,而40 mg阿托伐他汀组发生对比剂急性肾损伤5例,发生率为9.43%,两组相比差别有统计学意义(P<0.05)。结论应用对比剂前3天,每天服用40 mg阿托伐他汀较每天服用20 mg阿托伐他汀更能减少对比剂诱导的急性肾损伤的发生。

Aim To observe the effects of different atorvastatin doses on contrast induced acute kidney injury（CI-AKI） in patients undergoing coronary angiography（CAG） or percutaneous coronary intervention（PCI）. Methods 106 cases were randomized into 2 groups： one group received 20 mg atorvastatin at night and another group received40 mg atorvastatin at night,all patients received drug treatment for 3 days before CAG or PCI; all patients admitted to hospital within 24 hours completed routine inspections and examinations of heart ultrasound and renal vascular ultrasound and improved renal function in 48 hours after CAG or PCI and the preoperative,and postoperative modification of diet in renal disease（MDRD） method were used to estimate glomerular filtration rate（ eGFR）; all patients were taken 5 mL middle segment urine three times in the morning before CAG,2 hours and 48 hours after operation,and neutrophil gelatinase-associated lipocalin（NGAL） was detected with latex enhanced immunoturbidimetric. Results（1） The value of serum creatinine（SCr）（77. 44 ± 23. 14 mmol /L vs 94. 24 ± 36. 14 mmol /L,P = 0. 014）,uric acid（313. 05 ± 110. 84 μmol /L vs 354. 00 ± 100. 66 μmol /L,P = 0. 060） and eGFR（92. 24 ± 24. 74 vs 75. 31 ± 31. 34,P = 0. 009） after CAG or PCI were different between the two groups.（2）The value of 2 h NGAL（33. 13 ± 20. 44 μg /L vs 50. 67 ± 46. 95 μg /L,P =0. 013）,48 h NGAL（27. 56 ± 18. 64 μg /L vs 58. 38 ± 56. 81 μg /L,P = 0. 001） after CAG or PCI had statistically significant differences between the two groups.（3）The occurrence of CI-AKI was as follows： the 20 mg /d atorvastatin group had 11 cases,the incidence was 20. 75%,and the 40 mg /d atorvastatin group had 5 cases,the incidence was 9. 43%,there was statistical significance（P = 0. 04）. Conclusion Compared with 20 mg /d atorvastatin,40 mg /d atorvastatin for 3 days before CAG or PCI can reduce the occurrence of CI-AKI.