大剂量阿托伐他汀预防脑血管介入诊疗术后造影剂肾病的临床研究

Clinical study on effect of high dose atorvastatin in the prevention of contrast-induced nephropathy after cerebral vascular interventional therapy

目的研究大剂量阿托伐他汀预防脑血管介入术后造影剂肾病(CIN)的效果及其作用机制。方法选择2014年7-12月我院收治的95例行脑血管介入术诊疗的脑血管病患者为研究对象,随机分为对照组(46例)和观察组(49例)。术前3 d及术后,对照组口服阿托伐他汀20 mg/d,观察组于术前夜间予阿托伐他汀80 mg顿服,术后予阿托伐他汀40 mg/d。分别于术前24 h和术后24、72 h检测血肌酐(Scr)、肌酐清除率(Ccr)、血清尿素(BUN)、β2-微球蛋白(β2-M G)、胱抑素-C(CYS-C)、超敏C反应蛋白(hs-CRP)水平;以及术前24 h和术后72 h的血脂和肝功能水平,并进行对比分析。同时比较CIN和脑血管不良事件的发生率。结果两组患者术前24 h的Scr、Ccr、BUN、β2-M G、CYS-C、hs-CRP水平比较,差异均无统计学意义(P>0.05)。对照组术后各时间点Scr、β2-M G、CYS-C、hs-CRP均较术前升高,Ccr较术前降低,差异均有统计学意义(P<0.05)。观察组术后除CYS-C水平较术前升高(P<0.05)外,其余各项指标水平与术前比较,差异均无统计学意义(P>0.05)。两组患者之间术后各时间点各项指标的水平比较,观察组均优于对照组,差异有统计学意义(P<0.05)。两组患者术前术后肝功能和血脂水平组间及组内比较,差异均无统计学意义,无不良脑血管事件发生。结论脑血管介入术前给予大剂量阿托伐他汀可减轻肾损害,机制与其抑制炎症因子有关。

Objective To investigate the effect of high dose atorvastatin on the prevention of contrast-induced nephropathy （ CIN） and its mechanism. Methods Ninety-five cases diagnosed as cerebral vascular diseases and sched-uled for diagnostic and therapeutic cerebral vascular intervention in our hospital from July to December （ 2014 ） were divided into observation group （n=49） and control group （n=46） randomly. Patients in control group received atorv-astatin 20 mg/d at 3 d before operation and after operation,patients in observation group received atorvastatin 80 mg once per night before operation and 20 mg/d after operation. The Scr,Ccr,BUN,β2-MG,GYS-C,hs-CRP of the two groups were observed at 24 h before operation and 24,72 h after operation. The blood lipid level and liver function of the two groups were observed at 24 h before surgery and 72 h after operation. The adverse effects were recor-ded. Results There was no significant difference in the levels of Scr,Ccr,BUN,β2-MG,GYS-C,hs-CRP between the two groups at 24 h before operation（P〉0.05）. The Scr,β2-MG,GYS-C,hs-CRP levels in control group increased, while the Ccr decreased after operation （ P 〈0.05 ） . No significant difference was found in the above indexes （ P 〉0.05） except GYS-C in observation group after operation. The levels of the above indexes in observation group were better than those of control group （P〈0.05）. There was no significant difference in liver function and blood lipid lev-els between the two groups before and after operation （P〉0.05）. Conclusion High dose atorvastatin used before cer-ebral vascular interventional therapy can reduce kidney damage. The underlying mechanism may be related to the signif-icant inhibition of the inflammatory response.