前列地尔注射液对行经皮冠状动脉介入治疗的冠心病并糖尿病肾病患者肾功能的影响

Impact of Alprostadil Injection on Renal Function of Coronary Heart Disease Patients Complicated with Diabetic Nephropathy Undergoing PCI

目的探讨前列地尔注射液对行经皮冠状动脉介入治疗(PCI)的冠心病并糖尿病肾病(DN)患者肾功能的影响。方法选取2014年1月—2015年6月河北医科大学第二医院心内科收治的冠心病并DN患者107例,根据治疗方法分为对照组53例和试验组54例。两组患者均行PCI及标准水化治疗,对照组患者PCI前12 h静脉注射0.9%氯化钠注射液2 ml,PCI后静脉注射0.9%氯化钠注射液2 ml/次,1次/d,连续治疗6 d;试验组患者PCI前12 h静脉注射前列地尔注射液20μg,PCI后静脉注射前列地尔注射液20μg/次,1次/d,连续治疗6 d。比较两组患者PCI前及PCI后24、48、72 h估测肾小球滤过率(e GFR)、胱抑素C(Cys C),PCI前及PCI后1周尿清蛋白排泄率(UAER)和尿清蛋白/肌酐比值(ACR)。结果时间与方法在e GFR、Cys-C上存在交互作用(P<0.05);方法在e GFR、Cys-C上主效应显著(P<0.05);时间在e GFR、Cys-C上主效应显著(P<0.05);PCI后24 h、48 h、72 h,试验组患者e GFR高于对照组,Cys C低于对照组(P<0.05)。PCI前两组患者UAER、ACR比较,差异无统计学意义(P>0.05)。PCI后1周试验组患者UAER、ACR低于对照组(P<0.05);试验组患者PCI后1周UAER、ACR低于PCI前(P<0.05),而对照组患者PCI后1周UAER、ACR与PCI前比较,差异无统计学意义(P>0.05)。结论前列地尔注射液可有效抑制冠心病并DN患者PCI后Cys-C升高,提高e GFR,降低尿微量清蛋白含量,对患者肾功能具有一定保护作用。

Objective To investigate the impact of alprostadil injection on renal function of coronary heart disease patients complicated with diabetic nephropathy undergoing PCI. Methods From January 2014 to June 2015,a total of 107 coronary heart disease patients complicated with diabetic nephropathy were selected in the Department of Cardiology,the Second Hospital of Hebei Medical University, and they were divided into control group（ n = 53） and experiment group（ n = 54）according to therapeutic methods. Patients of the two groups received conventional PCI and standard hydration treatment,meanwhile patients of control group were given intravenous injection of 0. 9% sodium chloride injection（ 2 ml） before 12 hours of PCI,intravenous injection of 0. 9% sodium chloride injection（ 2 ml per time,1 time per day） after PCI for 6 days,while patients of experiment group were given intravenous injection of alprostadil injection（ 20 μg） before 12 hours of PCI,intravenous injection of alprostadil injection（ 20 μg per time,1 time per day） after PCI for 6 days. e GFR and Cys C before PCI,after 24 hours,48 hours and 72 hours of PCI,UAER and ACR before PCI and after one week of PCI were compared between the two groups. Results There was interaction between time and method in e GFR and Cys C（ P〈0. 05）; the main effects of time and method were significant in e GFR and Cys C（ P〈0. 05）; after 24 hours,48 hours and 72 hours of PCI,e GFR of experiment group was statistically significantly higher than that of control group, respectively, while Cys C of experiment group was statistically significantly lower than that of control group,respectively（ P〈0. 05）. No statistically significant differences of UAER or ACR was found between the two groups before PCI（ P〉0. 05）. After 1 week of PCI,UAER and ACR of experiment group were statistically significantly lower than those of control group（ P〈0. 05）; meanwhile UAER and ACR of experiment group were statistically significantly lower than those before PCI（ P〈0. 05）,while UAER and ACR of control group were not statistically significantly different compared with those before PCI（ P〉0. 05）. Conclusion Alprostadil injection can effectively inhibit the increase of Cys C of postoperative coronary heart disease patients complicated with diabetic nephropathy treated by PCI,improve the e GFR and reduce the urine trace albumin levels,has certain protective effect on renal function.