前列地尔对肾功能不全患者造影剂肾病的预防作用研究

Preventive effect of alprostadil on contrast-induced nephropathy in patients with renal insufficiency

目的探讨前列地尔对肾功能不全患者冠状动脉介入治疗后造影剂肾病的预防作用。方法连续收入2014年6月至2017年6月在民航总医院行急诊冠状动脉介入治疗或择期冠状动脉介入治疗的肾功能不全患者156例,完全随机分为2组,对照组79例,前列地尔组77例。对照组在术前、术中及术后给予水化+安慰剂,前列地尔组给予水化+前列地尔,前列地尔及安慰剂在术前30~90 min开始静脉滴注直至术后4 h结束。比较2组患者治疗前后血清尿素氮、肌酐、肾小球滤过率,以及终点事件发生情况。结果治疗后2组血清尿素较治疗前下降,对照组肾小球滤过率较治疗前下降,血肌酐增高,差异均有统计学意义(P <0. 05)。前列地尔组血肌酐和肾小球滤过率与治疗前比较,差异均无统计学意义(均P> 0. 05)。主要终点事件:对照组发生造影剂肾病16例(20. 3%),前列地尔组发生造影剂肾病9例(11. 7%),2组主要终点事件发生率比较差异无统计学意义(P=0. 141)。次要终点:对照组肌酐相对增加≥25%者14例(17. 7%),前列地尔组7例(9. 1%)。对照组肌酐浓度较基线水平绝对增加≥25μmol/L者比例高于前列地尔组,差异有统计学意义[25. 3%(20/79)比13. 0%(10/77),P=0. 047]。结论对于肾功能不全患者在行冠状动脉造影检查及冠状动脉介入治疗时,在水化的基础上前列地尔可能预防低危患者造影剂肾病的发生。

Objective To explore the preventive effect of alprostadil on patients with renal insufficiency after coronary intervention. Methods A total of 156 patients with renal insufficiency who underwent emergency coronary intervention or elective coronary intervention in the Civil Aviation General Hospital from June 2014 to June2017 were randomly divided into the control group( 79 cases) and alprodil group( 77 cases). The control group was given hydration + placebo before,during and after the operation,and the alprostadil group was given hydration +alprostadil. Alprostadil and placebo were intravenously infused from 30 to 90 minutes before surgery until after surgery4 h. Serum urea nitrogen,creatinine,glomerular filtration rate,and primary endpoint events were compared between the two groups before and after treatment. Results After treament,serum urea decreased in both groups;the glomerular filtration rate in the control group decreased and blood creatinine increased. There was no significant difference in serum creatinine and glomerular filtration rate in the alprostadil group before and after treatment( all P > 0. 05). Primary endpoint events: 16 cases( 20. 3%) of contrast nephropathy occurred in the control group and9 cases( 11. 7%) of contrast nephropathy occurred in the alprostadil group. There was no significant difference in the primary endpoint events between the two groups( P = 0. 141). Secondary endpoint: a relative increase in creatinine≥25% was observed in 14 cases in the control group and 7 cases( 9. 1%) in the alprostadil group. The creatinine concentration in the control group increased by≥25 μmol/L from the baseline level,which was higher than that of the alprostadil group;the difference was statistically significant [25. 3%( 20/79) vs 13. 0%( 10/77),P = 0. 047]. Conclusion For patients with renal insufficiency undergoing coronary angiography and coronary intervention,alprostadil may prevent the occurrence of contrast nephropathy in low-risk patients.