不同抗血小板药物对急性冠脉综合征患者行经皮冠状动脉介入术后对比剂急性肾损伤的影响

The influence of different antiplatelet drugs on contrast acute kidney injury after percutaneous coronary intervention in patients with acute coronary syndrome

目的探讨对急性冠脉综合征(ACS)患者行经皮冠状动脉介入术后应用不同抗血小板聚集药物对对比剂急性肾损伤(CIAKI)的影响。方法选择急性冠脉综合征并成功行冠状动脉血管造影(CAG)或经皮冠状动脉介入治疗(PCI)的143例患者,按随机数字表法分成2组:替格瑞洛治疗组(n=71),氯吡格雷治疗组(n=72),两组患者入院后均接受其他常规治疗,替格瑞洛治疗组术前给予替格瑞洛负荷量180 mg,行CAG术并予支架植入治疗(亦称为PCI)术后给予标准剂量90毫克/次,1天2次,记为替格瑞洛组(n=51),氯吡格雷治疗组术前给予氯吡格雷负荷量300 mg,行CAG术并予支架植入术后给予标准剂量75毫克/次1天1次,记为氯吡格雷组(n=56),仅行CAG术未予支架置入术后停用替格瑞洛及氯吡格雷,记为对照组(n=36)。统计患者的一般资料,术前、术后(24 h、48 h、72 h)的血肌酐(SCr)、胱抑素C(Cys C),计算肾小球滤过率(e GFR),并估测CIAKI发生情况。结果三组间术后48 h SCr与术前、术后(24 h、72 h) SCr的差异有统计学意义(P <0. 05),其中替格瑞洛组及氯吡格雷组术后SCr的平均水平高于对照组,替格瑞洛组术后SCr的平均水平高于氯吡格雷组;三组间术后24 h Cys C与术前、术后72 h Cys C的差异有统计学意义(P <0. 05);三组间术后48 h Cys C与术前、术后72 h Cys C的差异有统计学意义,其中替格瑞洛组及氯吡格雷组术后Cys C的平均水平高于对照组,替格瑞洛组术后Cys C的平均水平高于氯吡格雷组;三组间术后48h e GFR与术前、术后(24 h、72 h) e GFR的差异有统计学意义(P <0. 05),其中替格瑞洛组及氯吡格雷组术后e GFR平均水平低于对照组。替格瑞洛组Cys C与对照组Cys C差异有统计学意义(P <0. 05);氯吡格雷组Cys C与对照组Cys C的差异有统计学意义(P <0. 05)。时间和药物在SCr、Cys C指标变化上存在交互作用(P <0. 05)。三组间术后CIAKI的发生率差异无统计学意义(P> 0. 05),替格瑞洛组CIAKI发生率稍高于氯吡格雷组(5. 88%,5. 36%)。结论对于行PCI尤其术后需使用替格瑞洛抗血小板治疗的患者在围术期应尽可能予以保护肾功能及预防CIAKI的治疗措施。

Objective To investigate the effect of different antiplatelet aggregation drugs on contrast induced acute kidney injury (CIAKI) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention.Methods A total of 143 patients with acute coronary syndrome successfully underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI) were randomly divided into two groups:Treatment with ticagrelor (n=71),treatment with clopidogrel (n=72),all patients received other routine treatment after admission,and the patients in ticagrelor treatment group received ticagrelor load 180mg before surgery.CAG and stent implantation (also known as PCI) were given a standard dose of 90 mg/time,twice a day,recorded as ticagrelor group (n=51),and clopidogrel treatment group was given preoperatively.The clopidogrel load was 300 mg.After CAG and stent implantation,the standard dose was 75 mg/time once a day,which was recorded as clopidogrel group (n=56).Only CAG was not implanted.Ticagrelor and clopidogrel were discontinued after surgery and recorded as control group (n=36).Statistical data of patients,preoperative,postoperative (24 h,48 h,72 h) serum creatinine (SCr),cystatin C (CysC),calculate glomerular filtration rate (eGFR),and estimate the occurrence of CIAKI.Results There were significant differences in SCr between the three groups (P<0.05) and the preoperative and postoperative (24 h,72 h).The average level of SCr was higher in the ticagrelor group and the clopidogrel group.In the control group,the average level of SCr was higher in the ticagrelor group than in the clopidogrel group.There was a statistically significant difference in CysC between the three groups after 24h (P<0.05).The difference of CysC between the group and the 72 h after operation was statistically significant.The average level of CysC in the ticagrelor group and clopidogrel group was higher than that in the control group.The average level of CysC was higher than that of clopidogrel group.There was significant difference between eGFR and preoperative and postoperative (24 h,72 h) eGFR between the three groups (P<0.05).Among them,ticagrelor group and chlorine The average level of eGFR was lower in the pigrelan group than in the control group.There was significant difference between CysC and CysC in the control group (P<0.05).The difference between CysC in the clopidogrel group and CysC in the control group was statistically significant (P<0.05).There was an interaction between time and drug in the changes of SCr and CysC indexes (P<0.05).There was no significant difference in the incidence of postoperative CIAKI between the three groups (P>0.05).The incidence of CIAKI in the ticagrelor group was slightly higher than that in the clopidogrel group (5.88% vs 5.36%).Conclusion Patients who need to use ticagrelor antiplatelet therapy should be able to protect renal function and prevent CIAKI treatment during the perioperative period.