远程缺血后适应对急性ST段抬高型心肌梗死患者PCI治疗后的肾功能保护作用

Renoprotection by remote ischemic postconditioning in patients with STEMI undergoing percutaneous coronary intervention

目的评估远程缺血后适应(remote ischemic postconditioning,RIC)对急性ST段抬高型心肌梗死(STsegment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后减少急性肾损伤(acute kidney injury,AKI)的效果。方法选取苏州大学附属第一医院2014年诊断为STEMI并行急诊PCI治疗的患者150例,排除不符合条件的患者后根据随机数字表法随机分为两组。在开通罪犯血管后立即用血压计袖带反复对实验组患者上肢进行束缚。比较两组AKI的发生率并计算出各组估算肾小球滤过率(estimated glomerular filtration rate,e GFR),比较各组术前术后e GFR。结果符合条件的入选患者137例,其中RIC组71例,对照组66例。两组基线资料比较,差异无统计学意义(P>0.05)。RIC组AKI发生率9.9%,对照组为31.8%;RIC组术后3 d的AKI发生率明显低于对照组,差异有统计学意义(P<0.05)。对照组术后e GFR下降均值为(-13.199±22.34)m L·min-1·1.73 m-2,RIC组为(-2.29±19.34)m L·min-1·1.73 m-2;RIC组e GFR下降值小于对照组,差异有统计学意义(P<0.05)。结论 RIC可减少STEMI患者行急诊PCI治疗后AKI的发生率,并有保护患者肾功能的作用。

Objectives To assess the efficacy of remote ischemic postconditioning（RIC） by repeating blood pressure cuff inflations and deflations in one of the upper limbs and its value in preventing acute kidney injury（AKI） in patients with ST- segment elevation myocardial infarction（ STEMI） undergoing percutaneous coronary intervention（ PCI）.Methods Totally 150 patients with STEMI were enrolled in The First Affiliated Hospital of Suzhou University in 2014,and the eligible patients were randomized to receive RIC by cycles of inflation and deflation of the blood pressure cuff in one of the upper limbs once criminal vessel was opened up. The primary endpoint was AKI, and the secondary endpoint was change in estimated glomerular filtration rate（e GFR）. Results A number of 137 eligible patients were included.They were randomly divided into RIC group（71 patients） and control group（66 patients）. There were no significant differences in age, gender, hypertension, baseline serum creatinine, blood urea nitrogen（BUN） and e GFR before PCI between the two groups（P〉0.05）. AKI rate in RIC group was 9.9% versus 31.8% in controls three days after PCI.Patients in control group had a higher risk of AKI after PCI than those in RIC group（P〈0.05）. A sharp decrease of e GFR in control group was（-13.199±22.34） m L·min-1·1.73 m-2versus（-2.29±19.34） m L·min-1·1.73 m-2in RIC group. The decline of e GFR in control group was obviously sharper than that in RIC group（P〈0.05）. Conclusions RIC by repeating blood pressure cuff inflations and deflations during PCI is found to confer renoprotection and reduce the risk of AKI in patients with STEMI.