肢体缺血后处理预防对比剂肾病

Limb Ischemic Postconditioning for Prevention of Contrast Medium-induced Nephropathy

目的:前瞻性对照观测肢体缺血后处理(LI-postC)对预防对比剂肾病(CIN)的作用。方法:随机选取行冠脉造影和经皮冠脉介入(PCI)且存在轻-中度慢性肾功能不全[血肌酐(Scr):123-442μmol/L或肾小球滤过率(eGFR):15-60ml/min/1.73m^2]的患者100例,随机分为LI-postC组(n=50,造影后立即进行间歇性前臂LIpostC,4个循环)和对照组(n=50,不行LI-postC)。平行检测两组术前及术后24h、48h的Scr、eGFR、胱抑素C(CysC)、尿中性粒细胞明胶酶酯质运载蛋白(NGAL)水平,分析两组主要终点事件及复合心血管终点事件发生率。结果:LI-postC组术后24h及48hScr、CysC、NGAL低于对照组,eGFR高于对照组(术后24hScr和eGFR除外),差异均有统计学意义(P<0.05)。两组发生CIN患者共27例,LI-postC组8例(16.00%),对照组19例(38.00%),LI-postC组明显低于对照组(P<0.05)。两组发生复合心血管终点事件20例,LI-postC组4例(8.00%)、对照组16例(32.00%),LI-postC组明显低于对照组(P<0.05)。结论:LI-postC可能减少轻-中度慢性肾功能不全患者CIN的发生。

Objective：To observe the effect of limb ischemic postconditioning（LI-postC）on the prevention of contrast induced nephropathy（CIN）in a prospective controlled clinical trial.Method：Randomly selected 100 patients for coronary angiography and percutaneous coronary interventions（PCI）who existed in mild to moderate chronic renal insufficiency[creatinine（Scr）123-442μmol/L or estimate glomerular filtration rate（eGFR）15-60ml/min/1.73m^2],they were randomly divided into LI-postC group（immediately with forearm LI-postC for 4cycles after surgery,n=50）and control group（no LI-postC,n=50）.Scr and eGFR,Cystatin C（Cys C）,urinary neutral particle gelatinase ester matter carrier protein（NGAL）level at preoperative and postoperative 24 hand 48hwere deteded,and the incidence of primary end point events and composite cardiovascular end events in two groups were analyzed.Results：A total of 27 patients with CIN were occurred in two groups,8cases（16.00%）in LI-postC group,19 cases in control group（38.00%）,LI-postC group was significantly lower than control group（P〈0.05）.A total of 20 patients with compound cardiovascular end events were occurred in two groups,with which 4cases（8.00%）in LI-postC group and 16 cases in control group（32.00%）.The compound cardiovascular events of LI-postC group was significantly lower than the control group（P〈0.05）.Conclusion：LI-postC may reduce the incidence of CIN in patients with mild to moderate chronic renal insufficiency.