阿托伐他汀对老年冠心病患者PCI术后造影剂肾病的影响
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摘要
目的观察术前不同剂量阿托伐他汀联合水化疗法对老年冠心病患者PCI术后造影剂肾病的影响。方法选择2014年7月—2018年8月南京鼓楼医院集团安庆市石化医院心血管内科择期行PCI术的老年冠心病患者60例作为研究对象,随机数字表法分为常规组与强化组各30例,常规组给予小剂量阿托伐他汀联合水化疗法治疗,强化组采用大剂量阿托伐他汀联合水化疗法治疗,对2组PCI术后肾功能、炎性因子、造影剂肾病发生率及不良反应发生情况进行观察比较。结果强化组造影剂肾病发生率明显低于常规组(3.33%vs.26.67%,χ~2=4. 706,P=0. 030);强化组术后SCr、β_2-MG、及Cys-C水平低于常规组(t/P=2. 072/0. 043、11.087/0. 000、2.976/0. 043),eGFR水平高于常规组(t/P=2. 172/0.034), Lp-PLA2、NLR水平低于常规组(t/P=4. 616/0.000、5. 037/0. 000);2组总不良反应发生率比较无明显差异(12.50%vs.16.33%,χ~2=0.417,P=0.519)。结论术前大剂量阿托伐他汀联合水化疗法有效保护老年冠心病患者PCI术后的肾功能,其机制可能与阿托伐他汀抑制炎性反应相关。
Objective To observe the effect of different doses of atorvastatin combined with hydration therapy on contrast nephropathy after PCI in elderly patients with coronary heart disease. Methods From July 2014 to August 2018,60 patients with coronary heart disease who underwent elective PCI in the Department of Cardiology, Anqing Petrochemical Hospital of Nanjing Gulou Hospital Group were selected as subjects. The random number table method was divided into 30 cases in the conventional group and the intensive group. The conventional group was treated with low-dose atorvastatin combined with hydration therapy, and the intensive group was treated with high-dose atorvastatin combined with hydration therapy. The incidence of renal function, inflammatory factors, contrast nephropathy in 2 groups of PCI patients and The incidence of adverse reactions was observed and compared. Results The incidence of contrast-enhanced nephropathy was significantly lower in the intensive group than in the conventional group(3.33% vs. 26.67%,χ~2=4.706,P =0.030). The levels of SCr, β_2-MG,and Cys-C in the intensive group were lower than those in the conventional group(t/P =2.072/0.043, t/P = 11.087/0.000,t/P =2.976/0.043), eGFR levels were higher than the conventional group(t/P =2.172/0.034), Lp-PLA2, NLR levels were lower than the conventional group(t/P =4.616/0.000, t/P= 5.037/0.000); there was no significant difference in the incidence of total adverse reactions between the two groups(12.50% vs. 16.33%, χ~2 =0.417, P = 0.519).Conclusion Preoperative high-dose atorvastatin combined with hydration therapy can effectively protect renal function in elderly patients with coronary heart disease after PCI. The mechanism may be related to the inhibition of inflammatory response by atorvastatin.
Objective To observe the effect of different doses of atorvastatin combined with hydration therapy on contrast nephropathy after PCI in elderly patients with coronary heart disease. Methods From July 2014 to August 2018,60 patients with coronary heart disease who underwent elective PCI in the Department of Cardiology, Anqing Petrochemical Hospital of Nanjing Gulou Hospital Group were selected as subjects. The random number table method was divided into 30 cases in the conventional group and the intensive group. The conventional group was treated with low-dose atorvastatin combined with hydration therapy, and the intensive group was treated with high-dose atorvastatin combined with hydration therapy. The incidence of renal function, inflammatory factors, contrast nephropathy in 2 groups of PCI patients and The incidence of adverse reactions was observed and compared. Results The incidence of contrast-enhanced nephropathy was significantly lower in the intensive group than in the conventional group(3.33% vs. 26.67%,χ~2=4.706,P =0.030). The levels of SCr, β_2-MG,and Cys-C in the intensive group were lower than those in the conventional group(t/P =2.072/0.043, t/P = 11.087/0.000,t/P =2.976/0.043), eGFR levels were higher than the conventional group(t/P =2.172/0.034), Lp-PLA2, NLR levels were lower than the conventional group(t/P =4.616/0.000, t/P= 5.037/0.000); there was no significant difference in the incidence of total adverse reactions between the two groups(12.50% vs. 16.33%, χ~2 =0.417, P = 0.519).Conclusion Preoperative high-dose atorvastatin combined with hydration therapy can effectively protect renal function in elderly patients with coronary heart disease after PCI. The mechanism may be related to the inhibition of inflammatory response by atorvastatin.
引文
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[4]高建波,张茂,方国英,等.危重患者造影剂肾病的发生风险及危害[J].中华危重病急救医学,2015,27(5):366-370.DOI:10.3760/cma. j. issn.2095 4352.2015.05.009.
[5]丁文飞,王金艳,钟爱民.造影剂肾病的发病机制研究进展[J].江西医药,2014,8(6):554-556. DOI:10. 3969/j. issn. 1006-2238.2014.06.039.
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[8] Su X, Xie X, Liu L, et al. Comparative effectiveness of 12 treatment strategies for preventing contrast induced acute kidney injury:a systematic review and Bayesian network meta-analysis[J]. Am J Kidney Dis, 2017, 69(1):69-77. DOI:10. 1053/j. ajkd. 2016.07.033.
[9]许小进,张清,刘海浪,等.不同剂量阿托伐他汀对冠状动脉介人术后发生造影剂肾病的影响[J].中华老年心脑血管病杂志,2018,20(1):32-36. DOI:10. 3969/j. issn. 1009-0126. 2018. 01.009.
[10]李顺宝,田春凤,李放.对比剂肾病研究进展[J].中国医药导刊,2014,16(11):1407-1409.
[11]丁丁,王安才,王德国,等.正常高值血压者中性粒细胞/淋巴细胞比值与动脉硬化的相关性分析[J].疑难病杂志,2018,17(8):786-789. DOI:10.3969/j. issn. 1671-6450.2018.08.007.
[12] Kaya H, Erta F, Islamoglu Y, et al. Association between neutrophil to lymphocyte ratio and severity of coronary artery dissease[J]. Clnical and Applied Thrombosis/Hemostasis, 2014, 20(1):50-54.DOI:10.1177/1076029612452116.
[13] Kaya A, Kurt M, Tanboga IH, et al. Relation of neutrophil to lymphocyte ratio with the presence and severity of stable coronary artery disease[J]. Clinical and Applied Thrombosis/Hemostasis, 2014,20(5):473-477. DOI:10.1177/1076029612473517.
[14] Wang Y, Li SS, Na SP, et al. Characterization of lipoprotein-associated phospholipase A2 in serum in patients with stage 3-5 chronic kidney disease[J]. Am J Med Sci,2016,352(4):348-353. DOI:10. 1016/j. amjms. 2016.07.002.
[15]丁玉婷,王安才,王德国,等.胱抑素C与早期动脉粥样硬化的相关性研究[J].疑难病杂志,2016,15(12):1224-1227. DOI:10. 3969/j. issn. 1671-6450. 2016.12.004.
[2] Stacul F, van der Molen AJ, Reimer P, et al. Contrast induced nephropathy:updated ESUR Contrast Media Safety Committee guidelines[J]. Eur Radiol, 2011, 21(12):2527-2541. DOI:10. 1007/s00330-011-2225-0.
[3] Demirtas L, Turkmen K, Kandemir FM, et al. The possible role of interleukin-33 as a new player in the pathogenesis of contrast-induced nephropathy in diabetic rats[J]. Ren Fail, 2016,38(6):952-960. DOI:10.1007/s00330-011-2225-0.
[4]高建波,张茂,方国英,等.危重患者造影剂肾病的发生风险及危害[J].中华危重病急救医学,2015,27(5):366-370.DOI:10.3760/cma. j. issn.2095 4352.2015.05.009.
[5]丁文飞,王金艳,钟爱民.造影剂肾病的发病机制研究进展[J].江西医药,2014,8(6):554-556. DOI:10. 3969/j. issn. 1006-2238.2014.06.039.
[6] Weisbord SD, Palevsky PM. Prevention strategies for contrast-induced nephropathy[J]. Ann Intern Med, 2016, 164(7):511.DOI:10.7326/L16-0098.
[7] Bidram P,Roghani F,Sanei H,et al. Atorvastatin and prevention of contrast-induced nephropathy following coronary angiography[J]. J Res Med Sci,2015,20(1):1-6.
[8] Su X, Xie X, Liu L, et al. Comparative effectiveness of 12 treatment strategies for preventing contrast induced acute kidney injury:a systematic review and Bayesian network meta-analysis[J]. Am J Kidney Dis, 2017, 69(1):69-77. DOI:10. 1053/j. ajkd. 2016.07.033.
[9]许小进,张清,刘海浪,等.不同剂量阿托伐他汀对冠状动脉介人术后发生造影剂肾病的影响[J].中华老年心脑血管病杂志,2018,20(1):32-36. DOI:10. 3969/j. issn. 1009-0126. 2018. 01.009.
[10]李顺宝,田春凤,李放.对比剂肾病研究进展[J].中国医药导刊,2014,16(11):1407-1409.
[11]丁丁,王安才,王德国,等.正常高值血压者中性粒细胞/淋巴细胞比值与动脉硬化的相关性分析[J].疑难病杂志,2018,17(8):786-789. DOI:10.3969/j. issn. 1671-6450.2018.08.007.
[12] Kaya H, Erta F, Islamoglu Y, et al. Association between neutrophil to lymphocyte ratio and severity of coronary artery dissease[J]. Clnical and Applied Thrombosis/Hemostasis, 2014, 20(1):50-54.DOI:10.1177/1076029612452116.
[13] Kaya A, Kurt M, Tanboga IH, et al. Relation of neutrophil to lymphocyte ratio with the presence and severity of stable coronary artery disease[J]. Clinical and Applied Thrombosis/Hemostasis, 2014,20(5):473-477. DOI:10.1177/1076029612473517.
[14] Wang Y, Li SS, Na SP, et al. Characterization of lipoprotein-associated phospholipase A2 in serum in patients with stage 3-5 chronic kidney disease[J]. Am J Med Sci,2016,352(4):348-353. DOI:10. 1016/j. amjms. 2016.07.002.
[15]丁玉婷,王安才,王德国,等.胱抑素C与早期动脉粥样硬化的相关性研究[J].疑难病杂志,2016,15(12):1224-1227. DOI:10. 3969/j. issn. 1671-6450. 2016.12.004.