尼可地尔对冠状动脉介入治疗后造影剂肾病的预防作用

Preventive effect of nicorandil on contrast-induced nephropathy following coronary intervention

目的探讨围术期口服尼可地尔对经皮冠状动脉介入(PCI)治疗术后造影剂肾病(CIN)的预防作用。方法连续入选2018年1-12月于天津市胸科医院心内科行择期PCI治疗的冠状动脉粥样硬化性心脏病(冠心病)患者300例,按照随机数字表法分为尼可地尔组和对照组,各150例。尼可地尔组在水化基础上,于PCI术前1 d至术后3 d口服尼可地尔10 mg/次,3次/d;对照组仅给予水化。比较2组患者PCI术前及术后48、72 h血清肌酐、血尿素氮、胱抑素C、估算肾小球滤过率(e GFR)、高敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、超氧化物歧化酶(SOD)、丙二醛水平及CIN发生情况,分析CIN发生的影响因素。比较2组患者住院期间主要不良事件发生情况。结果术后48、72 h,尼可地尔组血清肌酐、血尿素氮、胱抑素C、hs-CRP、IL-6、丙二醛水平低于对照组,而e GFR、SOD水平高于对照组,差异均有统计学意义(均P <0. 05)。PCI术后尼可地尔组CIN发生率低于对照组[4. 0%(6/150)比11. 3%(17/150)],差异有统计学意义(P=0. 028)。多元Logistic回归分析结果表明,尼可地尔是冠心病患者PCI术后发生CIN的独立保护因素(比值比=0. 312,95%置信区间:0. 116~0. 838,P=0. 021)。尼可地尔组和对照组住院期间主要不良事件发生率比较,差异无统计学意义(P> 0. 05)。结论冠心病患者围术期口服尼可地尔对减少PCI术后CIN的发生可能具有一定作用。

Objective To investigate the preventive effect of nicorandil on contrast-induced nephropathy( CIN) in patients undergoing coronary percutaneous coronary intervention( PCI). Methods From January to December 2018,300 patients with coronary atherosclerotic heart disease( CHD) undergoing elective PCI in department of cardiology,Tianjin Chest Hospital were randomly divided into nicorandil group and control group,with 150 cases in each group. Patients in the nicorandil group took nicorandil 10 mg,3 times/d on 1 day before and 3 days after PCI on the basis of hydration therapy. The control group had simple hydration therapy. Levels of serum creatinine,blood urea nitrogen,cystatin C,estimated glomerular filtration rate( e GFR),high sensitivity C-reactive protein( hs-CRP),interleukin-6( IL-6),superoxide dismutase( SOD) and malondialdehyde( MDA) were detected before and 48,72 hours after PCI. Incidence of CIN and the influence factors were analyzed. Major adverse events were observed during hospitalization. Results At 48 and 72 hours after PCI,levels of serum creatinine,blood urea nitrogen,cystatin C,hs-CRP,IL-6 and MDA in nicorandil group were significantly lower while e GFR and SOD were higher than those in control group( all P < 0. 05). Incidence of CIN in nicorandil group was significantly lower than that in control group[4. 0%( 6/150) vs 11. 3%( 17/150)]( P = 0. 028). Multivariate logistic regression analysis showed that nicorandil was an independent protective factor of CIN after PCI( odds ratio = 0. 312,95% confidence interval: 0. 116-0. 838,P = 0. 021). There was no significant difference of the incidence of in-hospital major adverse events between groups( P > 0. 05). Conclusion Oral administration of nicorandil can reduce the incidence of CIN in CHD patients undergoing PCI.