不同剂量阿托伐他汀对缺血性脑卒中介入诊疗术后对比剂肾损害的预防作用研究

Different Doses of Atorvastatin for the Prevention of Contrast-induced Nephropathy in Patients with Ischemic Stroke after Cerebrovascular Interventions

目的探讨不同剂量阿托伐他汀对缺血性脑卒中介入诊疗术后对比剂肾损害的预防作用。方法选取2012年8月—2014年12月在首都医科大学附属北京世纪坛医院住院治疗的缺血性脑卒中患者194例,根据随机数字表法分为高剂量他汀组(n=98)和低剂量他汀组(n=96)。两组均在使用对比剂前开始口服阿托伐他汀,其中高剂量他汀组患者给予阿托伐他汀40 mg/d;低剂量他汀组给予阿托伐他汀20 mg/d。比较两组术前和术后24、48 h血肌酐(SCr)、血胱抑素C(Cys C)水平及术后SCr峰值、SCr增高值(△SCr)、对比剂肾病(CIN)发生率、不良反应发生情况等。结果两组男性比例、年龄≥70岁比例、高血压发生率、糖尿病发生率、血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)使用率、对比剂用量≥200 ml比例间差异均无统计学意义(P>0.05)。两组SCr水平间差异无统计学意义(P>0.05),不同时间点SCr水平间差异有统计学意义(P<0.05),治疗方法和时间在SCr水平上存在交互作用(P<0.05)。两组Cys C水平间差异有统计学意义(P<0.05),不同时间点Cys C水平间差异有统计学意义(P<0.05),治疗方法和时间在Cys C水平上存在交互作用(P<0.05)。高剂量他汀组术后SCr峰值、△SCr均低于低剂量他汀组,差异有统计学意义(P<0.05)。高剂量他汀组CIN发生率低于低剂量他汀组,差异有统计学意义(P<0.05)。两组术后7 d复查血常规、血生化和凝血功能均未见明显异常。结论高剂量阿托伐他汀对脑血管介入诊疗术后对比剂肾损害有一定的预防保护作用。

Objective To study the effects of different doses of atorvastatin on the prevention of contrast- induced nephropathy（ CIN） in patients with ischemic stroke after cerebrovascular interventions. Methods One hundred and ninety- four consecutive patients with ischemic stroke hospitalized in Beijing Shijitan Hospital,CMU from August 2012 to December 2014 were randomly assigned into high dose of atorvastatin group（ n = 98） and low dose of atorvastatin group（ n = 96）, and respectively took atrovastatin 40 mg/d,and atrovastatin 20 mg/d orally before contrast agent administration. Comparisons were made between the groups in terms of serum creatinine（ SCr）,serum cystatin C（ CysC） measured before,and at 24 h,48 h after cerebrovascular interventions,post- procedure mean peak SCr,post- procedure increase in SCr from baseline（ △SCr）,incidence of CIN and incidence of adverse reactions. Results No significant differences were found between the two groups in terms of proportion of male patients,ratio of patients aged ≥70 years old,incidence of hypertension,incidence of diabetes,percentage of patients using angiotensin converting enzyme inhibitors（ ACEI） / angiotensin receptor antagonist（ ARB）,proportion of patients using the dose of contrast agent ≥200 ml（ P〈0. 05）. Both groups had no obvious difference in mean SCr（ P〈0. 05）,but the SCr before procedure,at 24 h and 48 h after the procedure differed significantly between the groups（ P〈0. 05）. Treatment method and duration exerted interaction effects on SCr（ P〈0. 05）. The difference in the mean CysC between the groups was distinct（ P〈0. 05）. The CysC before procedure,at 24 h and 48 h after the procedure in the high dose of atorvastatin group were significantly different from those in the low dose of atorvastatin group（ P〈0. 05）. Treatment method and duration had interaction effects on CysC（ P〈0. 05）. The levels of peak SCr and △SCr were significantly lower in high dose of atorvastatin group than in low dose of atorvastatin group after procedure（ P〈0. 05）. The incidence of CIN was significantly higher in low dose of atorvastatin group than in high dose of atorvastatin group（ P〈0. 05）. Results of routine blood,biochemical and coagulation function indicators in both groups remeasured on the 7th day after procedure showed no obvious abnormalities. Conclusion High dose of atorvastatin offers protection against CIN in patients with ischemic stroke after cerebrovascular interventions.