强化阿托伐他汀防治经皮冠状动脉介入术后造影剂肾病的效果及对炎症应激反应的影响

Effect of enhanced atorvastatin in the prevention and treatment of contrast nephropathy after percutaneous coronary intervention and its effect on inflammatory stress response

目的:探讨增强阿托伐他汀剂量对经皮冠状动脉介入手术(PCI)后造影剂肾病(CIN)的防治效果及对炎症应激反应的影响。方法:选取100例行PCI治疗的患者为研究对象,根据阿托伐他汀使用剂量不同分为观察组和对照组,每组各50例。术前,观察组口服高剂量阿托伐他汀强化治疗;对照组口服常规剂量治疗。比较两组患者肾功能指标[血尿素氮(BUN)、血清肌酐(Scr)、胱抑素C(Cys C)和肾小球过滤率(eGFR)]、血管功能指标[血管内皮生长因子(VEGF)、内皮素-1(ET-1)和一氧化氮(NO)]、炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)和超敏C反应蛋白(hs-CRP)]、氧化应激因子[超氧化物歧化酶(SOD)、髓过氧化物酶(MPO)、总抗氧能力(TAC)]水平及CIN发生率。结果:术后,两组患者BUN、SCr、Cys C、VEGF、NO、IL-6、TNF-α、hs-CRP水平均升高(P<0.05),且观察组低于对照组(P<0.05),eGFR、 ET-1、MPO水平均降低(P<0.05),且观察组高于对照组(P<0.05);SOD和TAC水平均升高(P<0.05),且观察组高于对照组(P<0.05), MPO水平均降低(P<0.05),且观察组低于对照组(P<0.05);观察组患者CIN发生率低于对照组(P<0.05)。结论:强化剂量的阿托伐他汀能更有效防止PCI后CIN的发生,机制可能与改善血管功能、抑制炎症与氧化应激反应有关。

Objective:To investigate the effect of enhanced atorvastatin dose on the prevention and treatment of contrast agent nephropathy after percutaneous coronary intervention and the effect on the inflammatory stress response of the body.Methods:A total of 100 patients undergoing percutaneous coronary intervention were divided into observation group and control group according to the dosage of atorvastatin,50 cases in each group.Before surgery,the observation group received high dose of atorvastatin orally,while the control group received regular dose orally.The renal function indexes[blood urea nitrogen(BUN),serum creatinine(SCR),cystatin C(Cys C)and glomerular filtration rate(eGFR)],vascular function indices[VEGF,ET-1 and NO],Inflammatory factors[interleukin-6(IL-6),tumor necrosis factor(TNF-α)and hypersensitive C-reactive protein(hs-CRP)]and oxidative stress indicators[superoxide dismutase(SOD),myeloperoxidase(MPO),total antioxidant capacity(TAC)],and the incidence of contrast nephropathy(CIN)were detected and compared between the two groups before and after operation.Results:After operation,the levels of BUN,Scr,Cys C,VEGF,NO,IL-6,TNF-α,and hs-CRP in two groups were all increased(P<0.05),the observation group was lower than the control group(P<0.05).The level of eGFR,ET-1 and MPO were decreased(P<0.05),the observation group was higher than the control group(P<0.05).After operation,SOD and TAC levels in both groups were increased(P<0.05),observation group was higher than control group(P<0.05).MPO level was decreased,the observation group was lower than the control group(P<0.05).The incidence of CIN in the observation group was lower than that in the control group(P<0.05).Conclusion:Intensifying the dose of atorvastatin can prevent the occurrence of contrast agent nephropathy more effectively,the mechanism of which may be related to improving vascular function,inhibiting inflammation and oxidative stress response.