普罗布考预防冠心病合并糖尿病患者PCI术中发生急性肾损害观察

Preventive Effect of Probucol on Contrast-induced Acute Kidney Injury among Patients with Coronary Artery Disease Complicated with Diabetes Undergoing Percutaneous Coronary Intervention

目的:观察普罗布考预防合并糖尿病的冠心病患者实施经皮冠状动脉介入治疗(PCI)中发生对比剂急性肾损害(CIAKI)的作用。方法:92例在我院行PCI术的冠心病合并糖尿病患者随机分为对照组和干预组各46例。对照组采用水化预防CIAKI,干预组在对照组基础上加用普罗布考片。比较PCI术前后两组患者炎症因子、氧化应激、内皮功能、肾功能指标变化及CIAKI的发生率。对两组进行预后随访。结果:PCI术后,两组患者的IL-18、NGAL、KIM-1、SOD水平较术前明显升高,MDA、NO、NOS、ET-1水平较术前明显下降(P <0. 05);且干预组IL-18、NGAL、KIM-1、MDA、ET-1水平均明显低于对照组(P <0. 05),SOD、NO、NOS水平明显高于对照组(P <0. 05)。PCI术后,对照组患者的SCr、β_2-MG、CysC、BUN等指标水平较治疗前增高(P <0. 05),Ccr无明显变化(P> 0. 05);干预组治疗前后SCr、β_2-MG、CysC、BUN无明显变化(P> 0. 05),Ccr较PCI前增高(P <0. 05),且SCr、β_2-MG、CysC、BUN水平明显低于对照组,Ccr明显高于对照组(P <0. 05)。干预组CIAKI发生率和术后随访期预后不良事件发生例数均显著低于对照组(P <0. 05)。结论:普罗布考对合并糖尿病的冠心病患者CIAKI有较好的预防作用,其可有效抑制炎症、氧化应激,保护内皮功能和肾功能,改善预后。

Objective：To investigate the preventive effect of probucol on contrast-induced acute kidney injury （CIAKI） among patients with coronary artery disease complicated with diabetes undergoing percutaneous coronary intervention （PCI）. Methods：92 cases of patients with diabetes and coronary artery disease admitted for elective PCI in our hospital were divided randomly into control group （46 cases, receiving hydration therapy） and intervention group （46 cases, receiving additional probucol）. The changes in inflammation, oxidative stress, endothelial function, renal function, the inci- dences of CIAKI and prognosis were compared in two groups. Results：The levels of IL-18, NGAL, KIM-1, SOD increased dramatically and MDA, NO, NOS, ET-1 decreased after PCI in the two groups （P 〈 0.05 ） ; The levels of IL-18, NGAL, KIM-1, MDA and ET-1 after PCI in intervention group were significantly lower than those in the control group （P 〈 0.05 ）, and the levels of SOD, NO and NOS were significantly higher than those in the control group （P 〈 0.05）. The levels of SCr, β2-MG, CysC, BUN increased （P 〈 0.05） and the level of Ccr showed no significant change （P 〉 0.05 ） after PCI in the control group; The levels of SCr, β2-MG, CysC, BUN had no obvious changes after PCI in intervention group （ P 〉 0.05 ）, and Ccr increased after treatment （ P 〈 0.05 ）. Compared with the control group, the levels of SCr, β2-MG, CysC, BUN were significantly lower （ P 〈 0.05 ） and the Ccr were significantly higher in the intervention group （ P 〈 0.05 ）. The incidence of CIAKI and poor prognosis in the intervention group was significantly lower than that in the control group （P 〈 0.05 ）. Conclusion： Probucol had a satisfactory effect on the prevention of CIAKI among the patients with diabetes and cor- onary artery disease, and on inhibiting inflammation and oxidative stress, the protection of vascular endothelium and renal function, improving the prognosis.