前列地尔脂微球载体制剂对冠心病PCI患者造影剂肾病的预防作用

The preventive effect of alprostadil lipo preparation on contrast induced nephropathy in patients with PCI

目的探讨前列地尔月旨微球载体制剂对冠心病经皮冠状动脉介入治疗(PCI)患者造影剂肾病(CIN)的预防作用。方法 2012年7月—2015年7月重庆市第五人民医院肾内科诊治冠心病PCI患者245例,根据随机数字表法将患者分为观察组123例和对照组122例。对照组介入治疗前1 h按3 ml·kg^(-1)·h^(-1)速度静脉输注0.9%氯化钠注射液,观察组则给予前列地尔脂微球载体10μg+生理盐水100 nl静脉滴注。对比分析2组术前及术后24 h、48 h血肌酐(SCr)、钾离子(K^+)、尿素氮(BUN)及尿液pH值、肾小球滤过率(GFR)、尿转铁蛋白(TRF)、明胶酶脂质运载蛋白(NGAI)的差异。观察2组患者CIN及二级终点事件发生率情况。结果与术前比较,2组术后SCr、K^+、BUN、TRF、NGAL水平均升高,GFR降低,且观察组术后24 h、48 h时SCr、K^+、BUN、TRF、NGAL水平显著低于对照组(P<0.01),而GFR水平高于对照组(P<0.01)。观察组患者CIN发生率及二级终点事件发生率均显著低于对照组(2.44%vs.11.48%,0.81%vs.5.74%,P均<0.05)。结论对冠心病介入术患者术前使用前列地尔脂微球载体制剂能降低CIN的发生率,有效地保护肾脏功能。

Objective To investigate the preventive effect of lipo PGE1 in coronary heart disease （CHD） percutaneous coronary intervention （PCI） for the treatment of patients with contrast media induced nephropathy （CIN）. Methods From July 2012 to July 2015, 245 cases of patients with coronary heart disease in the Department of internal medicine Fifth People＇s Hospital of Chongqing City were enrolled, according to the random number table method, they were divided into the observation group of 123 cases and control group of 122 cases. The control group 1 h before intervention, given 3 ml · kg^-1 ·h^-1 intravenous infusion of 0. 9% sodium chloride injection, observation group give alprostadil lipo 10 μg ＋ physiological saline 100 ml intravenously. Comparative analysis of two groups preoperative and postoperative 24 h, 48 h, serum creatinine （ SCr）, potassium （ K ^＋ ）, blood urea nitrogen （BUN） and urine pH value, glomerular filtration rate （ GFR）, urinary transferrin （TRF）, gelatinase lipid lipocalin （NGAL） differences. The incidence rate of CIN and second grade event in the 2 groups were observed. Results Compared with those before operation, after operation, 2 group＇ s SCr, K^＋ , BUN, TRF, NGAL levels were increased, GFR were decreased, and in the observation group after 24 h and 48 h, SCr, K^＋ ,BUN,TRF, NGAL levels was significantly lower than those of control group （ P 〈 0.01 ）, and estimated GFR levels higher than that in the control group （ P 〈 0.05）. The incidence rate of CIN and second grade event incidence in the observation group were lower than those in the control group （2.44% vs. 11.48% ,0.81% vs. 5.74%, P 〈 0.05）. Conclusion For coronary interventional preoperative patients using lipo prostaglandin E1 can reduce CIN incidence and effectively protect renal function.