匹伐他汀联合乙酰半胱氨酸对经皮冠脉介入诊疗术患者对比剂肾病的治疗研究

Treatment of contrast-induced nephropathy with pitavastatin combined with N-acetylcysteine in patients undergone percutaneous coronary intervention

目的探讨常规剂量匹伐他汀钙片联合乙酰半胱氨酸对经皮冠状动脉介入治疗(PCI)后对比剂肾病(CIN)预防作用及可能的作用机制。方法选取2017年10月至2018年10月于保定市第一医院心内科择期行PCI的126例冠心病患者为研究对象,按照随机数字表法分为3组:对照组(A组,n=42)、常规剂量匹伐他汀组(B组,n=42)、常规剂量匹伐他汀联合乙酰半胱氨酸组(C组,n=42)。所有患者术前,术后24 h及72 h均抽取外周静脉血检测血肌酐(Scr)、丙二醛(MDA)及超氧化物歧化酶(SOD)水平。通过Cockcroft-Gault公式计算内生肌酐清除率(CCr)。结果3组入选患者术前一般临床资料及生化指标比较,差异均无统计学意义(P均>0.05)。与术前相比,术后24 h,A组Scr、MDA水平较术前均升高(P均<0.05),CCr水平较术前降低(P<0.05)。术后72 h,A、B组Scr及MDA水平较术前均升高(P均<0.05),CCr及SOD水平较术前均降低(P均<0.05)。与术前相比,C组术后24 h及术后72 h时,Scr、CCr、MDA及SOD的变化均没有统计学意义(P均>0.05);A、B、C组术后72 h CIN的发生情况分别为7例(16.7%)、3例(7.1%)、0例(0%),C组CIN的发生率低于A组,差异有统计学意义(P<0.05)。结论冠状动脉介入术(冠脉造影及支架植入术)患者术前服用匹伐他汀和乙酰半胱氨酸可在一定程度上保护肾功能,抗氧化应激可能是其主要的肾脏保护机制。

Objective To investigate the preventive effect of pitavastatin combined with N-acetylcysteine(NAC)in routine dose on contrast-induced nephropathy(CIN)in patients after percutaneous coronary intervention(PCI),and discuss possible effective mechanism.Methods The patients with coronary heart disease(CHD)undergone PCI(n=126)were chosen from Department of Cardiology in the First Hospital of Baoding City from Oct.2017 to Oct.2018.All patients were divided,according to random digital table,into control group(group A,n=42),routine-dose pitavastatin group(group B,n=42)and routine-dose pitavastatin combined with NAC group(group C,n=42).The levels of serum creatinine(SCr),malondialdehyde(MDA)and superoxide dismutase(SOD)were detected after collecting samples of peripheral venous blood from the patients before and after PCI for 24 h and 72 h.The endogenous creatinine clearance rate(CCr)was calculated by using Cockcroft-Gault formula.Results The comparison in general clinical materials and biochemical indexes showed the differences had no statistical significance among 3 groups before PCI(all P>0.05).Compared with before,the levels of Scr and MDA increased(all P<0.05)and level of CCr decreased(P<0.05)in group A after PCI for 24 h.The levels of Scr and MDA increased(all P<0.05)and levels of CCr and SOD decreased(all P<0.05)in groups A and B after PCI for 72 h.Compared with before,the changes of levels of Scr,CCr,MDA and SOD had no statistical significance in group C after PCI for 24 h and 72 h(all P>0.05).There were 7 cases(16.7%)of CIN in group A,3(7.1%)in group B and 0(0%)in group C,and CIN incidence rate was lower in group C than that in group A(P<0.05).Conclusion Pitavastatin combined with NAC taken before PCI can protect kidney function to some extent in CHD patients,and antioxidation stress may be the mechanism of protecting kidney function.