远端缺血预适应对老年非ST段抬高型心肌梗死患者造影剂肾病保护作用的研究

Role of remote ischemic preconditioning in protecting elderly non-STEMI patients against contrast-induced nephropathy

目的观察远端缺血预适应(RIPC)对造影剂肾病(CIN)早期诊断标志物的影响及肾脏的保护作用。方法选择老年非ST段抬高型心肌梗死行PCI患者220例,按照Grace评分及估算肾小球滤过率分层随机分为对照组110例,观察组110例。术前和术后水化,记录造影剂用量。检测术前、术后12、48 h及1个月肾功能指标,ELISA法检测中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子1(KIM-1)及视黄醇结合蛋白(RBP)水平。结果所有患者共发生CIN 27例(12.3%),观察组与对照组CIN发生率比较,差异无统计学意义(10.9%vs 13.6%,χ^2=0.38,P=0.50)。观察组术后12 h NGAL、KIM-1、RBP水平明显低于对照组(P<0.05,P<0.01)。观察组术后12 h NGAL、KIM-1及RBP差值水平明显低于对照组,术后48 h RBP变化水平明显低于对照组(P<0.05,P<0.01)。与非RIPC比较,RIPC患者Mehran风险评分中危RBP、KIM-1变化水平明显降低,低危、中危和高危NGAL变化水平明显降低(P<0.05,P<0.01)。结论RIPC未能降低老年非ST段抬高型心肌梗死患者CIN发生率,但应用更敏感的NGAL、KIM-1、RBP作为观察指标,能显示出RIPC对CIN的保护作用,尤其在损伤早期。

Objective To study the effect of remote ischemic preconditioning(RIPC)on biomarkers for early diagnosis of CIN and the role of RIPC in protecting elderly non-STEMI patients against CIN.Methods Two hundred and twenty elderly non-STEMI patients were randomly divided into control group(n=110)and observation group(n=110)according to their Grace score and eGFR.The hydration and contrast medium dose were recorded and the renal function was tested in two groups before and after PCI.The serum levels of neutrophil gelatinase-associated lipocalinr(NGAL),kidney injury molecule 1(KIM-1)and retinol binding protein(RBP)were measured by ELISA in two groups at 12 h,48 h and I month before and after PCI.Results CIN occurred in 27 patients(12.3%).No significant difference was detected in incidence of CIN between the two groups(10.9%vs 13.6%,χ^2=0.38,P=0.50).The serum levels of NGAL,KIM-1 and RBP were significantly lower in observation group than in control group at 12 h after PCI(P<0.05,P<0.01).The serum RBP level was significantly lower in observation group than in control group at 48 h after PCI(P<0.05,P<0.01).The Mehran risk scores of moderate RBP and KIM-1 and those of low,moderate and high NGAL were significantly lower in RIPC patients than in RIPC-free patients(P<0.05,P<0.01).Conclusion RIPC can not reduce the incidence of CIN in elderly non-STEMI patients,but can protect RIPC against CIN,especially early CIN when more sensitive NGAL,KIM-1 and RBP are used as the observation markers.