前列地尔联合强化阿托伐他汀预防糖尿病肾病患者对比剂急性肾损伤的临床研究

A Clinical Study of Alprostadil Combined with Atorvastatin on Prevention of Contrast Agent Induced Acute Kidney Injury in Diabetic Nephropathy Patients

目的探讨前列地尔联合强化阿托伐他汀能否减轻行经皮冠状动脉介入治疗(PCI)的糖尿病肾病(DN)患者由对比剂引起的急性肾损伤。方法选取拟行PCI且伴DN的196例患者为研究对象。将入选患者随机分为对照组、强化阿托伐他汀组、前列地尔组及联合治疗组4组,每组49例。入选所有患者常规给予抗血小板、抗凝、降血脂、降血压、控制血糖、扩冠等基础治疗。4组患者分别均于术前12h至术后12h内给予相同水化治疗。前列地尔组及联合治疗组患者术前30min,术后12、36、60h分别静脉注射前列地尔20μg,对照组及强化阿托伐他汀组则在对应时间点应用等剂量安慰剂(0.9%氯化钠注射液2ml)。强化阿托伐他汀组及联合治疗组患者于术前3天起每日加服阿托伐他汀20mg(总量至40mg/d)。观察4组患者术前及术后48、72h Cys C、Scr、β_2-MG、hs-CRP的变化情况,并比较这4组患者对比剂肾病(CIN)的发生率。结果 4组患者PCI前CysC、Scr、β_2-MG、hs-CRP水平比较,差异均无统计学意义(P>0.05);前列地尔组、强化阿托伐他汀组及联合治疗组3组患者PCI后48及72h的Cys C、β2-MG、hs-CRP水平均低于对照组(P<0.05)。而联合治疗组Cys C、β_2-MG、hs-CRP水平较其他组都低(P<0.05)。PCI后72h前列地尔组、联合治疗组及强化阿托伐他汀组患者Scr水平均低于对照组(P<0.05)。联合治疗组患者Scr水平最低(P<0.05)。联合治疗组患者对比剂肾病发生率为36.7%,明显低于其余3组(P<0.05)。结论静脉注射前列地尔联合强化阿托伐他汀可减轻由对比剂引起的急性肾损伤,并降低CIN发生率。

Objective To analyze whether the combination of alprostadil and high - dose atorvastatin can relieve acute kidney injury caused by contrast agent in DN patients treated with PCI. Methods The author took 196 DN patients treated with PCI as the study sub- jects. The patients were randomly divided into control group, high - dose atorvastatin group, alprostadil group and combination therapy group（n =49）. All patients were treated with regular treatments, including anti- platelet, anti- coagulation, anti- hyperlipidemia, Blood pressure control, blood sugar control, coronary dilatation and so on. The patients in the four groups were all treated with the same hydration therapy from pre- 12h to the post- 12h of the operation. The alprostadil group and the ecombination therapy group were given intravenous injection of 20μg alprostadil at 30 rain before operation, 12, 36 and 60h after operation. The control group and high -dose atorvastatin group were treated with the same dose of placebo at the corresponding time point（0.9% Sodium chloride injection 2ml）. The patients in high - dose atorvastatin group and combined therapy group daily plus atorvastatin 20mg （ total to 40rag/d） 3 days before opera- tion. The author observed the changing situations of CysC, Scr, β2 - MG and hs - CRP before and 48h, 72h after operation respectively. The author compared the morbidity of CIN of these four groups. Results There was no significant significance in level differences of Cy- sC, Scr, β2 - MG and hs - CRP between the four groups before PCI（P 〉0.05）. The levels of CysC, β2 - MG and hs - CRP of patients in alprostadil group and high - dose atorvastatin group and combination therapy group at 48h and 72h after operation were all lower than those in the control group（ P 〈 0. 05 ）. The levels of Scr of patients in alprostadil group and high - dose atorvastatin group and combination therapy group at 72h after operation was all lower than those in the control group（P 〈 0. 05）. The level of Scr of patients in combination therapy group was lowest（P 〈 0.05）. The morbidity of contrast- induced nephropathy was 36.7% in the combination group, which was significantly lower than the other three groups（P 〈 0.05 ）. Conclusion Intravenous injection of alprostadil combined with high - dose atorvastatin can relieve acute kidney injury caused by contrast agent and reduce the morbidity of CIN.