非诺贝特联合参附注射液对高尿酸血症冠心病患者PCI后对比剂急性肾损伤的影响研究

Effects of fenofibrate combined with Shenfu injection on contrast-induced acute kidney injury in hyperuricemia coronary heart disease patients after percutaneous coronary intervention

目的观察非诺贝特联合参附注射液对高尿酸血症冠心病患者经皮冠状动脉介入治疗(PCI)后对比剂急性肾损伤(CI-AKI)的影响,并探讨其相关机制。方法将164例择期行PCI的高尿酸血症冠心病患者随机分为对照组和观察组,每组82例。2组均常规给予降糖、降脂和抗凝等对症治疗,由同一组医生行PCI,术后给予水化治疗,观察组在术前1周开始给予非诺贝特片和参附注射液治疗,用至术后3 d。检测2组PCI术前(t_0)、术后6 h(t_1)、术后24 h(t_2)和术后48 h(t_3)尿液中中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及血肌酐(SCr)、尿素氮(BUN)、血尿酸(SUA)、丙二醛(MDA)、超氧化物歧化酶(SOD)、C反应蛋白(CRP)和IL-6水平,估算肾小球滤过率(eGFR),统计2组t_0—t_1、t_1—t_2和t_2—t_3时间段CI-AKI的发生情况。结果 2组NGAL水平在t_1、t_2和t_3时间点均明显高于t_0时(P均<0.05),但观察组升高的程度明显小于对照组(P<0.05);对照组SCr和BUN水平在t_2和t_3时间点均明显高于t_0时(P均<0.05),观察组SCr和BUN水平在t_2和t_3时间点均明显低于对照组(P均<0.05);对照组eGFR在t_2和t_3时间点均明显低于t_0时(P均<0.05),观察组eGFR在t_2和t_3时间点均明显高于对照组(P<0.05);对照组SUA水平在t_2和t_3时间点均明显低于t_0时(P<0.05),观察组SUA水平在t_1、t_2和t_3时间点均明显低于t_0时及对照组(P均<0.05);2组MDA水平在t_2和t_3时间点均明显低于t_0时(P均<0.05),且观察组降低的程度明显大于对照组(P<0.05);对照组SOD水平在t_2和t_3时间点均明显高于t_0时(P均<0.05),观察组SOD水平在t_1、t_2和t_3时间点均明显高于t_0时及对照组(P<0.05);2组CRP水平在t_1、t_2和t_3时间点均明显高于t_0时(P<0.05),但观察组升高的程度明显低于对照组(P<0.05);对照组IL-6水平在t_2和t_3时间点均明显高于t_0时(P<0.05),观察组IL-6水平在t_2和t_3时间点明显低于对照组(P<0.05)。观察组t_0—t_1和t_1—t_2时间段CI-AKI发生率明显低于对照组(P<0.05)。结论非诺贝特联合参附注射液可以有效改善高尿酸血症冠心病患者PCI术后肾功能,降低CI-AKI的发生率,可能与减轻肾脏的氧化应激和炎性反应有关。

Objective It is to observe the effects of fenofibrate combined with Shenfu injection on contrast-induced acute kidney injury( CI-AKI) in hyperuricemia coronary heart disease patients after percutaneous coronary intervention( PCI),and to explore its mechanism. Methods 164 patients with hyperuricemia coronary heart disease were randomly divided into control group and observation group,84 cases in each group. Both groups received routine use of hypoglycemic,anticoagulant and lipid-lowering symptomatic treatment and postoperatively hydration therapy,the PCI was carried out by the same doctors. The observation group was treated with fenofibrate tablets and Shenfu injection from one week before treatment to 3 days after treatment. The levels of neutrophil gelatinase-associated lipocalin( NGAL),serum creatinine( SCr),urea nitrogen( BUN),blood uric acid( SUA),serum malondialdehyde( MDA),superoxide dismutase( SOD),C reactive protein( CRP),IL-6 were determined before PCI( t_0),in 6 h( t_1),24 h( t_2),48 h( t_3) after PCI,estimated glomerular filtration rate( eGFR) was evaluated in both groups. The occurrence of CI-AKI in the period of t_0—t_1,t_1—t_2 and t_2—t_3 in both groups were calculated.Results The levels of NGAL and CRP at t_1,t_2 and t_3 were significantly higher than that at t_0 in both groups( P < 0. 05),and the increase of observation group was significantly lower than that in the control group( P < 0. 05). The levels of SCr,SOD,IL-6 and BUN at t_2 and t_3 after surgery were significantly increased while that of eGFR and SUA was significantly decreased at these time point in the control group( P < 0. 05),but the levels of SCr,IL-6 and BUN at t_2 and t_3 were significantly lower while that of eGFR was higher in the observation group than those in the control group( P < 0. 05),the levels of SUA were obviously lower while that of SOD was higher at t_1,t_2,t_3 than those at t_0 and in the control group( P < 0. 05). The levels of MDA at t_2 and t_3 were significantly lower that those at t_0 in both groups( P < 0. 05),but the decrease in the observation group was more significant than that in the control group( P < 0. 05). The incidence of CI-AKI in the time stage of t_0—t_1 and t_1—t_2 in the observation group was significantly lower than that in the control group( P < 0. 05). Conclusion Fenofibrate combine with Shenfu injection can effectively improve renal function and reduce the incidence of CI-AKI after PCI in the patients with hyperuricemia coronary heart disease,and the mechanism may be that it could relieve renal oxidative stress response and inflammatory reaction.