重组脑利钠肽对造影剂肾病的预防作用

Preventive effect of recombinant human brain natriuretic peptide on contrast-induced nephropathy

目的探讨重组人脑利钠肽(rhBNP)对造影剂肾病的预防作用。方法接受冠状动脉造影和/或经皮冠状动脉成形术治疗的冠心病患者524例,随机分为两组:对照组251例,实施单纯水化治疗;rhBNP组273例,加用rhBNP 0.005μg·kg^(-1)·min^(-1)持续静脉滴注,术前10min开始,持续24h。比较两组患者术前、术后24h和48h血清肌酐(SCr)、胱抑素C(CysC)和肾小球滤过率估算值(eGFR)。结果rhBNP组造影剂肾病发生率低于对照组(5.1%vs.11.2%)(P<0.05)。rhBNP组围手术期SCr、CysC和eGFR增高幅度低于对照组(P<0.01);rhBNP组术后24hCysC水平低于对照组(P<0.05)。结论在水化治疗基础上,小剂量rhBNP持续静脉滴注能进一步降低造影剂肾病的发生率。

Objective To explore the preventive effect of recombinant human brain natriuretic peptide（rhBNP）on contrast-induced nephropathy.Methods A total of 524 patients with coronary heart disease undergoing coronary angiography and/or percutaneous coronary intervention treatment was randomly divided into two groups.The patients in group A（251cases）were treated with conventional hydration therapy and those in group B（273cases）were treated with conventional hydration and intravenous infusion of rhBNP 0.005μg·kg^-1·min^-1 for 24 hours,which started at10 minutes before operation.Serum creatinine（SCr）and cystatin C（CysC）were detected and the estimated glomerular filtration rate（eGFR）was calculated before and at 24 and 48 hours after operation.Results The incidence of contrast-induced nephropathy in group B was lower than that in group A（5.1% vs.11.2%）（P〈0.05）.The increases of SCr,CysC,and eGFR were less in group B than those in group A（P〈0.01）.Serum level of CysC at 24 hours after operation was lower in group B than that in group A（P〈0.05）.Conclusion On the basis of conventional hydration therapy,intravenous infusion of low-dose rhBNP preoperatively can further reduce the incidence of contrastinduced nephropathy.