不同剂量阿托伐他汀对老年冠心病患者择期介入诊疗术后造影剂肾病的影响

The effect of treatment with atorvastatin in different dosage on contrast-induced nephropathy in elder with coronary heart disease after coronary angiography and/or percutaneous coronary intervention

目的探讨服用不同剂量阿托伐他汀对老年患者造影剂肾病（CIN）的影响。方法将我院住院治疗拟行冠状动脉造影术（CAG）和（或）经皮冠状动脉介入术（PCI）的年龄t〉60岁的冠心病患者200例随机分为两组：常规剂量组100例，术前2—3天和术后口服阿托伐他汀20tug，1次／晚；强化他汀组100例，术前2～3天和术后口服阿托伐他汀40mg，1次／晚。分别于术前24小时和术后24、48、72小时检测血肌酐（Scr）、超敏C反应蛋白（hs-CRP）及胱抑素c（Cys—c）水平，计算肾小球滤过率估测值（eGFR），同时比较造影剂肾病的发生率。结果两组患者间一般情况、危险因素、临床用药、手术时间、碘海醇用量等差异均无统计学意义（P〉0．05）。常规剂量组和强化他汀组介入诊疗术前和术后各时间点Scr、eGFR水平差异均无统计学意义（P〉0．05）。介入诊疗术后24、48、72小时时常规剂量组hs—CRP及Cys-C水平较强化他汀组升高，差异有统计学意义（P〈0．05）。介入诊疗术后强化他汀组3例（3％）发生CIN，常规剂量他汀组10例（10％）发生CIN，两组CIN发生率差异有统计学意义（X2=4．03，P〈0．05）。结论大剂量阿托伐他汀对冠状动脉造影术后CIN可能具有一定的预防保护作用，其机制可能与改善炎症反应有关。

Objective -To evaluate the effect of treatment with atorvastatin in different dosage on contrast-induced nephropathy in elder with coronary heart disease after coronary angiography （CAG） and/or percutaneous coronary intervention （PCI） in China. Methods 200 patients older than 60 with coronary heart disease who received CAG and/or PCI were randomly divided into intensive dose atorvasta- tin group with atorvastatin 40 mg/d（ the study group, n = 100） and conventional treatment group with ator- vastatin 20 mg/d （the control group, n = 100）. Serum was collected before surgery and 24 h,48 h ,72 h after surgery for serum creatinine（ Scr）, high sensitive C-reactive protein（hs-CRP） and cystatin-C （Cys-C）. The glomerular filtration rate （eGFR） was calculated using modified equation. Results No significantly difference was noted in baseline between two groups（P 〉 0.05 ）. The levels of Scr and eGFR showed no significantly difference between two groups（P 〉 O. 05 ）. The levels of hs-CRP and Cys-C were decreased in the intensive dose atorvastatin group compared with conventional treatment group 24 h,48 h, 72 h after surgery（P 〈 0.05 ）. Meanwhile, the incidence of contrast-induced nephropathy （CIN） was significantly different between these two groups in the postoperative 72 h follow-up[3% （3 cases） vs 10% （ 10 cases）, X2 = 4.03 ,P 〈 0.05 ]. Conclusion The intensive treatment of atorvastatin could be some preventive and protective value for CIN after CAG and/or PCI, and the mechanism may be related to anti-inflammation.