阿托伐他汀改善造影剂对肾功能的影响及对心绞痛患者介入治疗术后的影响研究

Effect of Atorvastatin on contrast agent induced renal function in angina pectoris patients undergoing interventional therapy

目的探讨阿托伐他汀对冠脉造影患者肾功能的影响及对心绞痛患者介入治疗术后的影响。方法选取2017年4月—2018年4月期间收治的80例单纯冠脉造影患者,利用随机数字表法分为对照组及观察组,各40例。另选取同期于我院行PCI术的稳定型心绞痛患者90例,采用随机数字表法分为A、B、C 3组,各30例。观察组冠脉造影术前2 d^3 d每晚口服阿托伐他汀,对照组未使用阿托伐他汀及其他调脂类药物;A组患者每晚口服10 mg阿托伐他汀,B组每晚口服20 mg阿托伐他汀,C组每晚口服30 mg阿托伐他汀,3组均于PCI术前3 d开始服用,对比观察组与对照组患者肾功能、尿微量蛋白及超敏C反应蛋白(hs-CRP),并对比不同剂量的阿托伐他汀对PCI术患者心肌保护作用及对炎症因子的影响。结果造影前,2组肾功能各项指标、尿微量蛋白各项指标及hs-CRP对比,差异无统计学意义(P>0.05)。造影后第1天,对照组Cys C较造影前升高,且高于观察组;GFR较造影前降低,且低于观察组,差异有统计学意义(P<0.05)。造影后第1天,对照组α1-MG、m ALB、TR F及hs-CR P均较造影前升高,且均高于观察组,差异有统计学意义(P<0.05)。术前,3组患者CK-MB、c Tn I、hs-CRP、IL-6、s ICAM-1对比,差异无统计学意义(P>0.05)。术后24 h,3组患者CK-MB、c Tn I均较术前升高,且A组较B组、C组高,B组较C组高,差异有统计学意义(P<0.05)。术后24 h,3组患者hs-CRP、IL-6、s ICAM-1均较术前升高,且A组较B组、C组高,B组较C组高,差异有统计学意义(P<0.05)。结论阿托伐他汀可有效改善冠脉造影引发的一过性微量蛋白尿及肾功能损伤,同时,大剂量的阿托伐他汀可有效保护心绞痛介入治疗患者的心肌功能,并有效减轻心肌损伤及炎症反应,在临床应用中具有重要意义。

Objective To investigate the effect of atorvastatin on contrast agent induced renal function in angina pectoris patients undergoing interventional therapy. Methods 80 patients with pure coronary angiography from April 2017 to April 2018 were selected, and they were divided into control group and observation group by random number table, with 40 cases in each group. 90 cases of stable angina pectoris with PCI were selected, and they were divided into A ,B, C group by random number table, with 30 cases in each group.Observation group orally took atorvastatin every night before coronary angiography for 2-3d, while control group took no atorvastatin or other regulating lipid drugs; A group took 10mg atorvastatin every night, B group orally took 20 mg atorvastatin every night, C group orally took 30mg atorvastatin every night, and three groups took atorvastatin before PCI for 3d.The renal function, urinary microprotein,high-sensitivity C-reactive protein （hs-CRP） were compared between observation group and control group.The effect of different doses of atorvastatin on myocardial protection and inflammatory factors in PCI patients were compared. Results Before radiography, there was no statistical difference in the renal function indexes, urinary microprotein indexes, hs-CRP between the two groups （f N0.05）;After radiography for 1d,the CysC of control group increased compared with that before radiography,andcontrol group was higher than observation group; The GFR decreased compared with that before radiography, and control group was lower than observation group （P〈0.05）; After radiography for 1d,the a 〉-MG, mALB, TRF, hs-CRP in control group increased compared with those before radiography, and control group was higher than observation group （P 〈0.05 ）; Before surgery, there was no statistical difference in the CK-MB, cTnl, hs-CRP, IL-6, sICAM-1 among the three groups （! 〉0.05）; After surgery for 24 h, the CK-MB and cTnl of three groups increased compared with those before surgery, A group was higher than B and C group, and B group was higher than C group （P〈0.05）;After surgery for 24h,the hs-CRP, IL-6,sICAM-1 in three groups increased compared with those before surgery, A group was higher than B and C group, and B group was higher than C group （! 〈0.05 ）.Conclusion Atorvastatin can effectively improve transient microalbuminuria and renal function caused by coronary angiography. The large dose of atorvastatin is able to effectively protect myocardium of angina pectoris patients with interventional therapy, reduce myocardial damage and inflammatory response, which has important significance in clinical application.