不同剂量阿托伐他汀对老年患者增强CT后造影剂肾病的预防作用

Preventive effect of different doses of atorvastatin on contrast induced nephropathy after contrast-enhanced CT scan in elderly patients

目的分析不同剂量阿托伐他汀对老年患者增强CT后造影剂肾病(CIN)的预防作用。方法选择2019年1月—2020年12月福建省立医院老年科收治的行增强CT检查的老年患者220例,采用随机数字表法分为强化组和常规组,每组110例。强化组接受强化剂量阿托伐他汀,常规组接受常规剂量阿托伐他汀。比较2组CIN发生率,检查前、检查后72 h肾功能指标[血肌酐(SCr)、尿素氮(BUN)、估算肾小球滤过率(eGFR)、胱抑素C(CysC)]及超敏C反应蛋白(hs-CRP)水平。结果强化组CIN发生率为4.55%(5/110),低于常规组的12.73%(14/110)(χ^(2)=4.666,P=0.031)。检查后72 h,强化组SCr、BUN水平与检查前比较无显著变化(P>0.05),而常规组SCr、BUN水平均高于检查前和强化组(P<0.01或P<0.05)。检查后72 h,2组eGFR均低于检查前,CysC及hs-CRP水平均高于检查前,但强化组变化幅度小于常规组(P<0.01)。结论老年患者CT增强扫描前使用强化剂量阿托伐他汀预处理,能减轻造影剂引起的炎性反应,改善肾功能,有效预防CIN。

Objective To analyze the preventive effect of different doses of atorvastatin on contrast induced nephropathy(CIN)after contrast-enhanced CT scan in elderly patients.Methods 220 elderly patients who underwent contrast-enhanced CT scan admitted to the Department of Geriatrics,Fujian Provincial Hospital from January 2019 to December 2020 were selected,and they were randomly divided into strengthening group and regular group using a random number table method,with 110 patients in each group.The strengthening group received enhanced dose of atorvastatin,while the regular group received conventional dose of atorvastatin.The incidence of CIN,renal function indicators(SCr,BUN,eGFR,CysC),and levels of hs-CRP before and 72 hours after examination between two groups were compared.Results The incidence of CIN in the strengthening group was 4.55%(5/110),was lower than 12.73%(14/110)in the regular group(χ^(2)=4.666,P=0.031).At 72 hours after the examination,there were no significant change in the levels of SCr and BUN in the strengthening group(P>0.05),while the levels of SCr and BUN in the regular group were higher than before the examination and in the strengthening group(P<0.01 or P<0.05).At 72 hours after examination,eGFR in both groups were lower than before examination,and the levels CysC and hs-CRP were on average higher than before examination.However,the amplitude of changes in the strengthening group was smaller than that in the regular group(P<0.01).Conclusion Preconditioning elderly patients with enhanced dose atorvastatin before CT enhancement scanning can reduce inflammatory reactions caused by contrast agents,improve renal function,and effectively prevent post CIN.