不同剂量阿托伐他汀对ACS合并慢性肾病非冠状动脉介入治疗患者心肾功能的影响

Effects of different dosages of atorvastatin on cardiac and renal function in patients with acute coronary syndrome combined with chronic kidney disease via non-coronary intervention

目的观察不同剂量的阿托伐他汀治疗急性冠脉综合征(ACS)合并慢性肾病非冠状动脉介入治疗患者对其心肾功能的保护作用及药物安全性。方法选择2015年4月至2016年4月在海南省人民医院医疗保健中心住院的ACS合并慢性肾病非冠状动脉介入治疗的患者180例,采用随机双盲的原则分成观察组(n=90)和对照组(n=90),两组在原有冠心病、肾功能不全治疗的基础上,观察组给予强化阿托伐他汀(40 mg/d)治疗,对照组给予常规剂量阿托伐他汀(20 mg/d)治疗。治疗3个月后,检测并比较两组患者治疗前及治疗后的甘油三酯(TC)、总胆固醇(CHOL)、低密度脂蛋白(LDL-C)、血清超敏C反应蛋白(hs-CRP)、血肌酐(Scr)、血尿素氮(BUN)、肾小球滤过率(e GFR)等指标,观察两组治疗后其他临床不良事件发生情况。结果治疗3个月后,两组患者的TC、CHOL、LDLC水平较治疗前均降低,差异均有统计学意义(P<0.05),但两组患者治疗后的TC、CHOL、LDL-CH水平比较,差异均无统计学意义(P>0.05);两组患者治疗后的血清hs-CRP水平均低于治疗前,且治疗组较对照组下降明显,差异均有统计学意义(P<0.05);两组患者治疗后的Scr、BUN水平均较治疗前降低,e GFR较治疗前升高,差异均有统计学意义(P<0.05),但两组患者治疗后的Scr、BUN、e GFR比较,差异均无统计学意义(P>0.05);临床随访3个月后,两组患者的全因死亡率、急性心力衰竭、再发心绞痛和快速性心律失常等临床不良事件发生率比较差异均无统计学意义(P>0.05)。结论不同剂量阿托伐他汀通过调脂及抗氧化、抗炎等非降脂作用,降低肾功能相关指标,使肾小球滤过率上升,从而使肾功能不全进展延缓。对于ACS合并慢性肾病非冠状动脉介入患者,强化阿托伐他汀对心肾功能的保护作用更有效。

Objective To observe the effect of different dosages of atorvastatin on cardiac and renal function and drug safety in patients with acute coronary syndrome（ACS） combined with chronic kidney disease via non-coronary intervention. Methods According to the randomized double-blind principle, 180 ACS patients with kidney disease via non-coronary intervention from April 2015 to April 2016, in Hainan Provincial People’s Hospital medical center, were divided into observation group（n=90） and control group（n=90）. On the basic treatment of kidney dysfunction and heart disease, the observation group was given intensive atorvastatin（40 mg/d）, and the control group was given a conventional dose of atorvastatin（20 mg/d）. After 3 months of treatment, indexes were compared between the two groups before and after treatment, including triglyceride（TC）, total cholesterol（CHOL）, low density lipoprotein（LDL-C）, serum highsensitivity C reactive protein（hs-CRP）, serum creatinine（Scr）, blood urea nitrogen（BUN）, glomerular filtration rate（e GFR）, and clinical adverse events were observed in the two groups after treatment. Results After 3 months of treatment,TC, CHOL and LDL-C levels of the two groups were decreased significantly compared with before treatment（P〈0.05）,but the levels showed no significant differences between the two groups（P〉0.05）. The serum level of hs-CRP after treatment was lower than that before treatment in both two groups, and the decrease in the observation group was more significant than that in the control group（P〈0.05）. Scr and BUN levels after treatment were decreased significantly in both two groups and e GFR was increased significantly（P〈0.05）, but there were no significant differences in Scr, BUN and e GFR between two groups（P〉0.05）. A 3-month clinical follow-up indicated that there was no significant difference between the two groups in the incidence of events（P〉0.05）, including acute heart failure and all-cause mortality, recurrent angina and arrhythmia. Conclusion Different dosages of atorvastatin can reduce the renal function related indexes and increase the glomerular filtration rate by lipid regulation, anti-oxidation, anti-inflammatory effect, and other non-lipidlowering effects. For patients with ACS combined with chronic kidney disease, the effect of atorvastatin on renal function is more effective.