静脉应用尼可地尔对冠心病患者冠脉介入治疗后对比剂肾病的影响

Effect of Intravenous Nicorandil on Contrast-induced Nephropathy after Coronary Interventional Therapy in Patients with Coronary Heart Disease

目的探讨注射用尼可地尔对冠心病患者冠脉介入治疗术后对比剂肾病(CIN)的预防作用。方法选择2018年1月至2020年1月在聊城市人民医院心内科行经皮冠脉介入手术(PCI)的冠心病患者100例,采用随机数表法分为对照组和尼可地尔组,每组50例。观察的主要结果是CIN的发生率,CIN定义为在给予碘对比剂后48~72 h内肾功能损害[测量为血清肌酐(SCr)较原有水平升高25%或血清肌酐绝对值增加0.5 mg/dl(44.2μmol/L)]。次要终点是患者应用对比剂后24 h、48 h及72 h SCr、尿素、胱抑素C、β2-微球蛋白和肾小球滤过率的变化。结果尼可地尔组的CIN发生率低于对照组(2%∶14%),差异有统计学意义(P=0.027)。尼可地尔组术后24、48及72 h SCr、尿素、胱抑素C、β2-微球蛋白水平较对照组明显降低,肾小球滤过率较对照组明显升高,差异均有统计学意义(P<0.05)。结论冠心病患者预防性静脉内应用尼可地尔可降低介入治疗术后的CIN发生率。

Objective To explore the preventive effect of nicorandil for injection on contrast-induced nephropathy(CIN)after coronary interventional therapy in patients with coronary heart disease.Methods A total of 100 patients with coronary heart disease who underwent percutaneous coronary intervention(PCI)in the Department of Cardiology of Liaocheng People’s Hospital from January 2018 to January 2020 were selected and divided into control group and nicorandil group by random number table,with 50 cases in each group.The main result of the observation was the incidence of CIN,which was defined as renal impairment[measured as a 25%increase in serum creatinine(SCr)compared to the original level or an absolute increase in SCr by 0.5 mg/dl(44.2μmol/L)].The secondary endpoints were changes in SCr,urea,cystatin C,β2-microglobulin,and glomerular filtration rate at 24,48,and 72 hours after the application of the contrast agent.Results The incidence of CIN in the nicorandil group was lower than that in the control group,and the difference was statistically significant(2%vs.14%,P=0.027).The levels of SCr,urea,cystatin C,andβ2-microglobulin in the nicorandil group were significantly lower than those in the control group,and the glomerular filtration rate in the nicorandil group was significantly higher than that in the control group at 24,48 and 72 hours after surgery,the difference was statistically significant(P<0.05).Conclusion Prophylactic intravenous use of nicorandil for injection in patients with coronary heart disease can reduce the incidence of CIN after interventional therapy.