强化阿托伐他汀治疗对经皮冠状动脉介入治疗后对比剂肾病患者的保护作用

Protective effect of intensive atorvastatin in patients with contrast-induced nephropathy after percutaneous coronary intervention

目的研究强化阿托伐他汀治疗对经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后对比剂肾病(contrast induced nephropathy,CIN)患者肾功能的影响。方法将89例拟行PCI治疗的患者,采用随机数字表法分为空白组(35例)、强化他汀组(31例)、水化组(23例)。强化组住院期间予阿托伐他40 mg/d,水化组围术期予0.9%氯化钠注射液静脉注射。观察患者术前、术后血清肌酐(serum creatinine,Scr)及尿素氮(blood urea nitrogen,BUN)浓度的变化情况。结果空白组PCI治疗后Scr、BUN浓度均较术前有升高,强化他汀组PCI治疗后肾功能指标较术前轻微下降,水化组PCI治疗前后上述指标无明显变化,差异无统计学意义(P>0.05)。空白组PCI治疗后Scr、BUN变化值与强化他汀组、水化组比较,差异均有统计学意义(P<0.05);而强化他汀组与水化组之间Scr、BUN变化值比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示干预措施(包括强化他汀和水化治疗)是CIN的保护因素(OR=8.274,95%CI:2.254~30.37,P<0.05)。结论强化阿托伐他汀治疗对使用对比剂的患者有肾功能保护作用,其结果可能与水化治疗一致。

Objectives To evaluate the protective efficacy of intensive atorvastatin treatment on contrast induced nephropathy（CIN）in patients treated with percutaneous coronary intervention（PCI）. Methods Totally 89 patients treated with PCI were randomly divided into three groups：one group （n = 31） received intensive treatment with atorvastatin 40 mg/d,another patients（n=23）received intravenous saline hydration and the rest patients as the blank control group（n = 35）. Concentrations of urea nitrogen（blood BUN）,serum creatinine（Scr）were compared among the 3 groups before and 48-72 hours after the procedure. Results After PCI,concentrations of BUN and Scr in blank control group increased than those before PCI （P〈0.05）;they slightly decreased in intensive atorvastatin treatment group and had no difference in saline hydration group（P〉0.05）. Changes of concentrations of BUN and Scr among the 3 groups had significant differences after PCI ,but they had no statistical difference between intensive atorvastatin treatment group and saline hydration group. Multi-factor Logistic regression analysis showed that atorvastatin and saline hydration may prevent CIN after PCI（OR=8.274,95% CI：254-0.37,P〈0.05）. Conclusions Intensive atorvastatin treatment can protect renal function in patients with CIN after PCI ,which has the same outcome as saline hydration.