阿托伐他汀与氟伐他汀预防脑血管造影术后造影剂肾病的作用

The comparative effects of atorvastatin with fluvastatin on the prevention of contrast-induced nephropathy after digital subtraction angiography

目的比较阿托伐他汀和氟伐他汀在预防全脑血管造影术后造影剂肾病(CIN)的有效性及安全性。方法回顾性分析我院2012-01—2014-12行全脑血管造影检查的患者180例,随机分为阿托伐他汀组88例,DSA检查前3d开始服用阿托伐他汀20mg,qn;氟伐他汀组92例,DSA检查前3d开始服用氟伐他汀钠胶囊40mg,qn。观察2组术前及术后肾功能、肝功能、肌酶变化及CIN的发病率。结果阿托伐他汀组在预防全脑血管造影术后CIN的有效性方面较氟伐他汀组效果更好,阿托伐他汀组术前后Scr、Ccr变化值与氟伐他汀组比较差异具有统计学意义(P<0.05)。2组CIN发病率分别为对照组11.4%(10/88),常规组17.3%(16/92),阿托伐他汀组的CIN发病率小于氟伐他汀组(P<0.05)。2组术后7dALT、AST、CK与术前比较均无明显升高(P>0.05),但氟伐他汀组手术前后ALT、AST升高值与阿托伐他汀组比较差异具有统计学意义(P<0.05)。结论在预防全脑血管造影术后CIN方面,阿托伐他汀较氟伐他汀更能有效地减轻造影剂对肾功能的损害,明显降低全脑血管造影术后CIN的发病率,而且对于肝脏的损害更轻,安全性更好。

Objective To compare the efficacy and safety of atorvastatin with fluvastatin on the prevention of contrastinduced nephropathy（CIN）after digital subtraction angiography（DSA）. Methods Totally 180 patients who underwent DSA examination in our hospital from Jan. 2012 to Dec. 2014 were retrospectively analyzed. Three days before DSA examination, all cases were randomly divided into atorvastatin group（n= 88）receiving 20 mg of atorvastatin per night and the fluvastatin group taking 40 mg of fluvastatin each night. Then we observed the renal function, liver function, changes of muscle enzymes and the incidence of CIN in both two groups before and after operation. Results Compared with the fluvastatin group, the atorvastatin group was more effective on the prevention of CIN after DSA. The changes of Scr as well as Ccr before and after the operation showed significant differences between two groups（P〈0.05）. The incidence of CIN in the atorvastatin group was 11.4%, significantly lower than 17.3% in the fluvastatin group（P〈0.05）. On the 7th day after the operation, the levels of ALT, AST and CK were not obviously increased when compared with those before the operation, but significant differences were found between the fluvastatin group and the atorvastatin group in terms of the increasing levels（P〈0.05）. Conclusions Compared with fluvastatin, atorvastatin can protect renal function better from damage, can reduce the incidence of CIN obviously, and can be safer as for its damage to liver function on the prevention of CIN after DSA.