不同剂量阿托伐他汀对行经皮冠状动脉支架植入术治疗患者术后发生造影剂肾病的影响

Effects of different doses of atorvastatin on contrast induced nephropathy inpatients after PCI treatment

目的探讨不同剂量阿托伐他汀对行经皮冠状动脉支架植入术(PCI)患者术后发生造影剂肾病(CIN)的影响。方法分析2016年3月至2017年3月在安徽医科大学第一附属医院行PCI的128例急性心肌梗死患者(AMI)的临床资料,采用随机序贯综合平衡法随机分为强化组(64例,术前给予阿托伐他汀80 mg·d-1)和常规组(64例,术前给予阿托伐他汀20 mg·d-1),比较不同剂量阿托伐他汀治疗后患者PCI术后肾小球滤过率(e GFR)、血清肌酐(SCr)、尿β2球蛋白、胱抑素C(Cys C)、肌酸激酶(CK)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)以及CIN发生率的变化。结果强化组比常规组PCI术后3 d CK水平增高;术后3 d的Cys C水平以及术后2、3 d的Scr水平降低,差异有统计学意义(P<0.05);强化组的术后CIN发生率低于常规组(P=0.03);两组e GFR、SCr、尿β2球蛋白以及CK的不同时间水平间差异有统计学意义(均P<0.001)。多元logistic回归结果显示年龄、高血压、心功能衰竭以及阿托伐他汀剂量为经PCI治疗的患者术后发生CIN的独立危险因素,其中强化组患者术后发生CIN的概率相比常规组患者降低32%(OR:0.68,95%CI:0.560.83,P<0.05)。结论大剂量的阿托伐他汀可降低AMI患者经PCI治疗后发生CIN的概率,可保护患者肾脏功能,值得临床推广应用。

Objective To explore the effects of different doses of atorvastatin on contrast induced nephropathy（CIN） in patients after percutaneous coronary intervention（PCI） treatment. Method From March 2016 to march 2017,we the clinical datas of 128 cases of patients with acute myocardial infarction（AMI） in our hospital were analyzed which were randomly divided into strengthening group（n= 64,with 80 mg of atorvastatin） and regular group（n = 64,with 20 mg of atorvastatin） according to the dosage of atorvastatin given before PCI. The postoperative glomerular filtration rate（e GFR）,serum creatinine（Scr）,Urine beta 2 globulin,Cystatin C（Cys C）,creatine kinase（CK）,AST and ALT of different groups were tested in all patients. The rates of CIN after PCI were also compared between the two groups. Results There were higher level of CK of PCI postoperative 3 days and lower level of Cys C of PCI postoperative 3 days,SCr of PCI postoperative 2 and 3 days in strengthening group than in the regular dose group（P〈0. 05）. The rates of CIN was lower in the strengthening group than that in the regular group（P = 0. 03）. The level of e GFR,SCr,Urine beta 2 globulin and CK in two groups had statistically significant difference between different time（respectively P〈0. 001）. The result of multiple Logistic regression showed that age,hypertension,heart failure,and dose of atorvastatin were independent risk factors for CIN of patients treated by PCI.And there was lower probability of CIN patients after PCI with 32% lower in strengthening group than in the regular group（OR： 0. 68,95% CI： 0. 56-0. 83,P〈0. 05）. Conclusion Administration of high dose atorvastatin before PCI may decrease the occurrence of CIN after PCI for AMI patients and protect the patient＇s kidney function. It was worth clinical popularization and application.