静脉用尼可地尔对冠心病合并肾功能不全患者对比剂肾病的预防及肾保护作用探讨

Protective effect of intravenous infusion of nicorandil on contrast-induced nephropathy in coronary heart disease patients with renal insufficiency

目的探究静脉用尼可地尔(nicorandil)对冠心病合并肾功能不全(renal insufficient)患者对比剂肾病(contrast-inducednephropathy,CIN)的预防及肾保护作用。方法选取2017年10月-2018年10月于解放军总医院第一医学中心心内科行冠脉介入治疗(percutaneous coronary intervention,PCI)的冠心病合并肾功能不全患者150例,随机分为对照组(75例)和试验组(75例),年龄30~75岁,男86例,女64例。对照组患者给予常规静脉水化处理:术前12h至术后24h按照1.0ml/(h·kg)持续静滴0.9%氯化钠注射液。试验组术前12 h 至术后24 h 按1.0 ml/(h·kg)液速持续静滴尼可地尔注射液。比较两组造影前和造影后24h、48的血清肌酐(serum creatinine,Scr)、尿β2 微球蛋白(β2-microglobulin,β2-MG)、胱抑素C(cystatin,Cys C)水平以及两组CIN 的发生率。结果两组患者术前基线资料无统计学差异(P>0.05)。两组患者在造影后24 h、48 h血Scr、Cys C、尿β2-MG均有不同程度升高,对照组较试验组升高更为明显[Scr(90.88±18.28)μmol/L vs (105.46±31.86)μmol/L;Cys-C(1.28±0.45)μmol/L vs (1.52±0.76)μmol/L;尿β2-MG(0.063±0.064)μmol/L vs (0.104±0.043)μmol/L]。CIN 发生率对照组为9.33%(7/75),试验组为1.33%(1/75),两组间CIN 发生率差异有统计学意义(P=0.032)。结论静脉用尼可地尔能够降低冠心病合并肾功能不全患者对比剂肾病发病率。

Objective To investigate the protective effect of intravenous infusion of nicorandil on contrast induced nephropathy(CIN) in coronary heart disease patients with renal insufficiency. Methods One hundred and fifty patients with renal insufficiency undergoing percutaneous coronary intervention(PCI) in the first medical center, Chinese PLA General Hospital from October2017 to October 2018 were consecutively enrolled in our study. All patients were randomly divided into control group(n=75) and experimental group(n=75). Patients in control group were treated with conventional intravenous hydration(continuously intravenous infusion of 0.9% sodium chloride injection from preoperative 12 h to postoperative 24 h), and experimental group with intravenous infusion of nicorandil(continuously intravenous infusion of nicorandil from preoperative 12 h to postoperative 24 h). The serum creatinine(Scr), cystatin(Cys C) and urine β2-MG were measured on admission before PCI and at 24 h, 48 h after PCI, and the incidences of contrast induced nephropathy(CIN) of the two groups were observed. Results There was no significant difference in baseline characteristics between two groups(P >0.05). However, significant increase was observed in SCr and Cys-C levels at 24 and 48 h(P <0.05) in both two groups. Nicorandil group had a lower SCr and Cys-C levels than control group at 48 h after the procedure(SCr, 90.88±18.28 μmol/L vs 105.46±31.86 μmol/L;Cys-C, 1.28±0.45 vs 1.52±0.76 μmol/L;urine β2-MG,0.063±0.064 μmol/L vs 0.104±0.043 μmol/L). Correspondingly, the incidence of CIN was lower in nicorandil group than in control group(9.33% vs 1.33%, P=0.032). Conclusion Nicorandil can protect renal function and prevent CIN in patients with renal insufficient undergoing PCI.