hs-CRP水平对急性冠状动脉综合征患者PCI术后肾功能损害的影响及阿托伐他汀的干预效果

Effect of hs-CRP levels on renal function impairment in patients with acute coronary syndrome after PCI and the effect of atorvastatin

目的探讨高敏C反应蛋白（hs-CRP）水平对于急性冠脉综合征（ACS）患者经皮冠状动脉介入（PCI）术后急性肾功能损害的影响以及阿托伐他汀的干预效果。方法将272例ACS患者根据术前hs-CRP水平分为三组：hs-CRP明显升高组177例（hs-CRP≥3mg/L）、hs-CRP升高组62例（hs-CRP1~3mg/L）以及hs-CRP正常组33例（hs-CRP＜1mg/L）。再依据术前阿托伐他汀的用量，将177例hs-CRP水平明显升高组患者进一步分为40mg组60例，20mg组65例及10mg组52例。所有患者均在术前、术后1d、2d分别测定血肌酐（Scr）、血尿素氮（BUN）、胱抑素C（CysC）以及hs-CRP的水平，再依据Scr水平计算肌酐清除率（CCr），依据CysC计算出肾小球滤过率（GFR）。以术后发生急性对比剂肾损害（CIAKI）为因变量，利用多因素Logistic回归分析肾功能损害的影响因素。结果与hs-CRP正常组相比，hs-CRP明显升高组患者术后CysC和Scr较高，GFR水平较低（P＜0.05）；此外hs-CRP升高组术后CysC较高、GFR值较低（P＜0.05），但是Scr水平组间差异无统计学意义（P＞0.05）。272例患者中有104例发生CI-AKI，发生率为38.2%，其中hs-CRP明显升高组78例（44.07%），hs-CRP升高组22例（35.48%）以及hs-CRP正常组7例（21.1%），三组间CI-AKI的发生率差异具有统计学意义（P＜0.05）。hs-CRP明显升高组患者中阿托伐他汀40mg组患者术后GFR水平显著高于10mg及20mg组患者（P＜0.05），CysC及hs-CRP水平显著低于阿托伐他汀10mg组，而20mg组术后hs-CRP水平也显著低于10mg组（P＜0.05）。Logistic回归分析显示，高剂量阿托伐他汀是术后发生CI-AKI的保护因素，术前明显高水平的hs-CRP、糖尿病、肾功能不全以及高龄是CI-AKI的独立性危险因素（P＜0.05）。结论高水平hs-CRP是急性冠脉综合征接受PCI治疗患者肾功能损害的独立性危险因素。PCI术前给予高剂量的阿托伐他汀可明显降低hs-CRP升高程度，减少对比剂对肾脏功能的损害。

Objective To investigate the effect of high-sensitivity C-reactive protein (hs-CRP) on contrastinduced acute kidney injury(CI-AKI) in patients with acute coronary syndrome (ACS) after percutaneous coronaryintervention (PCI) and the effect of atorvastatin intervention. Methods According to the level of preoperative hs-CRP, 272 ACS patients were divided into three groups: significant high hs-CRP group (hs-CRP≥3 mg/L, n=177),high hs-CRP group (hs-CRP1-3 mg/L, n=62) and normal hs-CRP group (hs-CR<1mg/L, n=33). According to thedosage of preoperative atorvastatin, the significant high hs-CRP group was further divided into 10 mg group (n=52),20 mg group (n=65) and 40 mg group (n=60). Serum creatinine (Scr), blood urea nitrogen (BUN), cystatin C (Cys C),hs-CRP were measured before and at 1 day and 2 days after PCI. Creatinine clearance rate (CCr) and glomerularfiltration rate (GFR) were calculated according to Scr and Cys C. Risk factors for CI-AKl were determined bymultivariate Logistic regression analysis. Results The levels of Cys C and Scr were higher and the GFR level waslower in significant high hs-CRP group than that in normal hs-CRP group after PCI (P<0.05). The level of Cys Cwas higher and the GFR level was lower in high hs-CRP group than that in normal hs-CRP group after PCI (P<0.05),but there was no significant difference for Scr (P>0.05). CI-AKI occurred in 104 patients (38.2%), 78 (44.07%) insignificant high hs-CRP group, 22 (35.48%) in high hs-CRP group and 7 (21.1%) in normal hs-CRP group. Thedifference of CI-AKI occurrence rate was statistically significant (P<0.05). The GFR level was higher in 40 mggroup than that in 20 mg group and 10 mg group after PCI (P<0.05). The levels of Cys C and hs-CRP were lowerin 40 mg group and 20 mg group than that in 10 mg group (P<0.05). Results of logistic regression analysis showedthat high dose of atorvastatin was the protective factor of postoperative CI-AKI. Preoperative high levels of hs-CRP,diabetes mellitus, renal insufficiency and high age were independent risk factors of CI-AKI (P<0.05). Conclusion High levels of hs-CRP were independent risk factors for CI-AKI in patients with ACS undergoing PCI. The highdose of atorvastatin before PCI can significantly reduce the hs-CRP level, and reduce the contrast agent on renalfunction damage.