卡托普利防治老年冠脉造影或介入治疗造影剂肾病55例临床观察

Clinical Observation on Captopril in the Prevention and Treatment of Radiographic Contrast Nephropathy After Coronary Angiography or Interventional Therapy in Elderly Patients

目的探讨卡托普利防治老年冠状动脉粥样硬化性心脏病(简称冠心病)患者冠状动脉造影或介入治疗术后造影剂肾病的临床效果及作用机制。方法选择医院2016年1月至2017年1月接受冠状动脉造影或介入治疗的老年冠心病患者110例,随机分为对照组和治疗组,各55例。对照组患者于使用造影剂前24 h至术后48 h服用安慰剂淀粉片,而治疗组患者则同期口服卡托普利片。结果造影后,两组患者的血清肌酐(SCr)水平明显上升,肌酐清除率(CCr)及肾小球滤过率(GFR)均明显下降(P<0.05);治疗组患者的肾小球功能损伤程度比对照组更低;造影后72 h,两组患者的上述指标均优于造影后48 h;对照组患者血清GFR,SCr,CCr水平与造影前比较,差异有统计学意义(P<0.05);治疗组造影剂肾病发生率为3.64%,明显低于对照组的7.27%(P<0.05)。结论老年冠心病患者冠状动脉造影或介入治疗术中所用造影剂会影响肾小球功能,继而导致肾小球肾病,而卡托普利可有效防治和减轻造影剂肾病。

Objective To investigate the clinical effect of captopril in the prevention and treatment of coronary angiography or radiographic contrast nephropathy after interventional therapy in elderly patients with coronary heart disease and its mechanism of action.Methods Totally 110 elderly patients with coronary heart disease undergoing coronary angiography or interventional therapy in our hospital from January 2016 to January 2017 were selected and randomly divided into the control group and the treatment group,55 cases in each group.The control group was given Placebo Starch Tablets from 24h before the contrast agent to 48h after the operation,while the treatment group was given Captopril Tablets in the same period.Results After angiography,the serum serum creatinine(SCr)levels of the two groups were significantly increased,the creatinine clearance rate(CCr)and glomerular filtration rate(CFR)were significantly decreased(P<0.05),The damage degree of glomerular function in the treatment group was lower than that in the control group(P<0.05).Compared with 48h after angiography,the above indexes in the two groups were better at 72 h after angiography(P<0.05).The serum GFR,SCr and CCr levels in the control group were significantly different from those before angiography(P<0.05).The incidence rate of radiographic contrast nephropathy in the treatment group was 3.63%,which was significantly lower than 7.27%in the control group(P<0.05).Conclusion Contrast agents used in coronary angiography or interventional therapy in elderly patients with coronary heart disease may affect the glomeruli function and lead to glomerular nephropathy,but captopril can effectively prevent and reduce radiographic contrast nephropathy.