替格瑞洛对择期冠脉支架植入术患者造影剂肾病发病率影响

Effect of ticagrelor on incidence of contrast induced nephropathy in patients undergoing elective coronary stent implantation

目的:比较替格瑞洛和氯吡格雷对择期经皮冠脉支架植入术(percutaneous coronary stent implantation,PCI)患者造影剂肾病(contrast induced nephropathy,CIN)发病率的影响。方法:回顾性分析2014年1月—2016年9月在武汉市第四医院收治的择期行PCI的患者245例,其中替格瑞洛组58例,氯吡格雷组187例,统计患者的一般资料、PCI术前及术后72 h的血肌酐水平(Scr)、血尿酸(SUA)水平、肌酐差值和绝对值、血尿酸差值以及CIN的发生情况。结果:对择期PCI患者,替格瑞洛组与氯吡格雷组术前Scr和SUA水平无统计学差异;术后72 h Scr和SUA水平无统计学差异;而2组术前及术后72 h Scr差值、Scr绝对值和SUA差值均有统计学差异(P<0.05)。2组的CIN发病率无统计学差异。结论:对于择期PCI患者,与氯吡格雷相比,替格瑞洛能显著增加血肌酐和血尿酸水平,虽在造影剂肾病的发病率方面无统计学差异,但仍要警惕替格瑞洛加重CIN高危患者急性肾损伤的可能性。尤其是,替格瑞洛在CIN高危患者中的安全性仍需大规模前瞻性临床研究证实。在PCI围手术期,予以预防性治疗很有必要。

Objective： To compare the incidence of contrast induced nephropathy（ CIN） in patients undergoing elective percutaneous coronary stent implantation（ PCI） with ticagrelor and clopidogrel. Methods： A review of 245 patients undergoing elective PCI from January 2014 to September 2016 in Number four of Wuhan hospital was retrospectively analyzed,including 58 cases in ticagrelor group,187 cases in clopidogrel group. The general data of patients,the serum creatinine（ Scr） and the serum uric acid（ SUA） level before surgery and 72 hours after PCI,creatinine difference,creatinine absolute value,serum uric acid difference,and the occurrence of CIN from patients in both groups were compared. Results： The general data and medication of both groups were comparable. The ticagrelor group and the clopidogrel group had no statistical significance in preoperative Scr and SUA level; the both group also had no statistical significance in Scr and SUA level 72 hours after PCI; however,creatinine difference,creatinine absolute value and serum uric acid difference were statistically significant（ P〈0. 05）. The incidence of CIN in the both groups was not statistically significant. Conclusion： This study showed that compared with the clopidogrel group,the ticagrelor group significantly increased serum creatinine and uric acid levels in patients with elective PCI. Although the incidence of CIN has no statistical significance,we should still pay attention that ticagrelor in high-risk patients with CIN may aggravated damage the function of renal. A largeprospective clinical research still needs to be confirmed. It is necessary to have a preventive treatment in the perioperative period of PCI.