前列地尔对老年冠心病介入治疗患者造影剂肾病预防作用的多中心研究
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摘要
目的探讨短期应用前列地尔对老年冠心病患者择期行PCI术后造影剂肾病(CIN)的预防作用,进一步分析前列地尔降低CIN发生率的可能机制。方法选择2016年12月～2017年6月天津市胸科医院、天津市第四中心医院、天津市第一中心医院、泰达国际心血管病医院心内科择期行PCI的冠心病患者440例,按照随机数字表法分为对照组220例,前列地尔组220例。比较2组术后CIN发生率,术前和术后血肌酐、高敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、尿素、胱抑素C、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipoprotein,NGAL)水平变化。记录住院期间不良药物反应发生情况。结果所有患者中,CIN 23例(5.2%)。前列地尔组CIN发生率明显低于对照组,差异有统计学意义(2.3%vs 8.2%,χ~2=7.817,P=0.005)。2组术后血肌酐、hs-CRP水平较术前明显升高,eGFR、胱抑素C、尿素水平较术前明显降低,差异有统计学意义(P<0.05)。对照组术后NGAL水平较术前明显升高,差异有统计学意义(P<0.05)。前列地尔组术后NGAL、胱抑素C、hs-CRP水平明显低于对照组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,前列地尔是CIN的保护因素(OR=0.261,95%CI:0.095～0.716,P=0.009)。结论前列地尔对冠心病患者术后CIN的发病有一定预防作用。
Objective To study the preventive effect of alprostadil for contrast-induced nephropathy(CIN)in elderly CHD patients after PCI and its mechanism.Methods Four hundred and forty CHD patients for elective PCI were randomly divided into control group(n=220)and alprostadil treatment group(n=220).The incidence of CIN,serum Scr,hypersensitive C-reactive protein(hsCRP),blood urea nitrogen(BUN),cystatin C(Cyc),neutrophil gelatinase-associated lipoprotein(NGAL)levels and estimated glomerular filtration rate(eGFR)were compared between the two groups before and after PCI.The incidence of adverse drug reactions during their hospital stay time was recorded.Results CIN occurred in 23(5.2%)out of the 440 patients included in this study.The incidence of CIN was significantly lower in alprostadil treatment group than in control group(2.3%vs 8.2%,χ~2=7.817,P=0.005).The serum Scr and hs-CRP levels were significantly higher while the eGFR and serum Cyc and BUN levels were significantly lower in two groups after PCI than before PCI(P<0.05).The serum NGAL level was significantly higher in control group after PCI than before PCI(P<0.05).The serum levels of NGAL,Cyc and hs-CRP wer significeantly lower in alprostadil treatment group than in control group after PCI(P<0.05,P<0.01).Multivariate logistic regression analysis showed that alprostadil was a preventive factor for CIN in elderly CHD patients after PCI(OR=0.261,95%CI:0.095-0.716,P=0.009).Conclusion Alptrostadil is a preventive factor for CIN in elderly CHD patients after PCI.
Objective To study the preventive effect of alprostadil for contrast-induced nephropathy(CIN)in elderly CHD patients after PCI and its mechanism.Methods Four hundred and forty CHD patients for elective PCI were randomly divided into control group(n=220)and alprostadil treatment group(n=220).The incidence of CIN,serum Scr,hypersensitive C-reactive protein(hsCRP),blood urea nitrogen(BUN),cystatin C(Cyc),neutrophil gelatinase-associated lipoprotein(NGAL)levels and estimated glomerular filtration rate(eGFR)were compared between the two groups before and after PCI.The incidence of adverse drug reactions during their hospital stay time was recorded.Results CIN occurred in 23(5.2%)out of the 440 patients included in this study.The incidence of CIN was significantly lower in alprostadil treatment group than in control group(2.3%vs 8.2%,χ~2=7.817,P=0.005).The serum Scr and hs-CRP levels were significantly higher while the eGFR and serum Cyc and BUN levels were significantly lower in two groups after PCI than before PCI(P<0.05).The serum NGAL level was significantly higher in control group after PCI than before PCI(P<0.05).The serum levels of NGAL,Cyc and hs-CRP wer significeantly lower in alprostadil treatment group than in control group after PCI(P<0.05,P<0.01).Multivariate logistic regression analysis showed that alprostadil was a preventive factor for CIN in elderly CHD patients after PCI(OR=0.261,95%CI:0.095-0.716,P=0.009).Conclusion Alptrostadil is a preventive factor for CIN in elderly CHD patients after PCI.
引文
[1]Mamoulakis C,Tsarouhas K,Fragkiadoulaki I,et al.Contrastinduced nephropathy:basic concepts,pathophysiological implications and prevention strategies[J].Pharmacol Ther,2017,180:99-112.DOI:10.1016/j.pharmthera.2017.06.009.
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[7]Fu N,Yang S,Zhang J,et al.The efficacy of probucol combined with hydration in preventing contrast-induced nephropathy in patients with coronary heart disease undergoing percutaneous coronary intervention:a multicenter,prospective,randomized controlled study[J].Int Urol Nephrol,2018,50(1):105-112.DOI:10.1007/s11255-017-1718-4.
[8]Wong PC,Li Z,Guo J,et al.Pathophysiology of contrastinduced nephropathy[J].Int J Cardiol,2012,158(2):186-192.DOI:10.1016/j.ijcard.2011.06.115.
[9]Watanabe M,Saito Y,Aonuma K,et al.Prediction of contrastinduced nephropathy by the serum creatinine level on the day following cardiac catheterization[J].J Cardiol,2016,68(5):412-418.DOI:10.1016/j.jjcc.2015.10.016.
[10]Quintavalle C,Anselmi CV,De Micco F,et al.Neutrophil gelatinase-associated lipocalin and contrast-induced acute kidney injury[J].Circ Cardiovasc Interv,2015,8(9):e002673.DOI:10.1161/CIRCINTERVENTIONS.115.002673.
[11]Franke RP,Jung F.Pathophysiology of the contrast media-induced nephropathy(CIN)in patients undergoing coronary interventions[J].Clin Hemorheol Microcirc,2013,53(1-2):143-153.DOI:10.3233/CH-2012-1582.
[12]Ye Z,Lu H,Guo W,et al.The effect of alprostadil on preventing contrast-induced nephropathy for percutaneous coronary intervention in diabetic patients:a systematic review and meta-analysis[J].Medicine(Baltimore),2016,95(46):e5306.DOI:10.1097/MD.0000000000005306.
[13]Li WH,Li DY,Qian WH,et al.Prevention of contrast-induced nephropathy with prostaglandin E1in high-risk patients undergoing percutaneous coronary intervention[J].Int Urol Nephrol,2014,46(4):781-786.DOI:10.1007/s11255-014-0674-5.
[14]Zhang JZ,Kang XJ,Gao Y,et al.Efficacy of alprostadil for preventing of contrast-induced nephropathy:a meta-analysis[J].Sci Rep,2017,7(1):1045.DOI:10.1038/s41598-017-01160-1.
[15]Wang J,Ai X,Li L,et al.Alprostadil protects type 2diabetes mellitus patients treated with metformin from contrastinduced nephropathy[J].Int Urol Nephrol,2017,49(11):2019-2026.DOI:10.1007/s11255-017-1639-2.
[16]Miao Y,Zhong Y,Yan H,et al.Alprostadil plays a protective role in contrast-induced nephropathy in the elderly[J].Int Urol Nephrol,2013,45(4):1179-1185.DOI:10.1007/s11255-013-0484-1.
[17]Liang M,Yang S,Fu N,et al.Efficacy of alprostadil in preventing contrast-induced nephropathy in patients undergoing percutaneous coronary intervention:a multicenter prospective randomized controlled trial[J].Catheter Cardiovasc Interv,2018,91(4):742-750.DOI:10.1002/ccd.27353.
[18]Shang W,Wang Z.The Update of NGAL in acute kidney injury[J].Curr Protein Pept Sci,2017,18(12):1211-1217.DOI:10.2174/1389203717666160909125004.
[19]Wang K,Duan CY,Wu J,et al.Predictive value of neutrophil gelatinase-associated lipocalin for contrast-induced acute kidney injury after cardiac catheterization:a meta-analysis[J].Can J Cardiol,2016,32(8):1033.e19-e29.DOI:10.1016/j.cjca.2015.09.011.
[2]Koulouridis I,Price LL,Madias NE,et al.Hospital-acquired acute kidney injury and hospital readmission:a cohort study[J].Am J Kidney Dis,2015,65(2):275-282.DOI:10.1053/j.ajkd.2014.08.024.
[3]Fahling M,Seeliger E,Patzak A,et al.Understanding and preventing contrast-induced acute kidney injury[J].Nat Rev Nephrol,2017,13(3):169-180.DOI:10.1038/nrneph.2016.196.
[4]Weisbord SD,Palevsky PM.Prevention strategies for contrastinduced nephropathy[J].Ann Intern Med,2016,164(7):511.DOI:10.7326/L16-0098.
[5]Windecker S,Kolh P,Alfonso F,et al.2014 ESC/EACTSguidelines on myocardial revascularization[J].Euro Intervention,2015,10(9):1024-1094.DOI:10.4244/EIJY14M09_01.
[6]Yang SC,Fu NK,Zhang J,et al.Preventive effects of alprostadil against contrast-induced nephropathy inpatients with renal insufficiency undergoing percutaneous coronary intervention[J].Angiology,2018,69(5):393-399.DOI:10.1177/0003319717730942.
[7]Fu N,Yang S,Zhang J,et al.The efficacy of probucol combined with hydration in preventing contrast-induced nephropathy in patients with coronary heart disease undergoing percutaneous coronary intervention:a multicenter,prospective,randomized controlled study[J].Int Urol Nephrol,2018,50(1):105-112.DOI:10.1007/s11255-017-1718-4.
[8]Wong PC,Li Z,Guo J,et al.Pathophysiology of contrastinduced nephropathy[J].Int J Cardiol,2012,158(2):186-192.DOI:10.1016/j.ijcard.2011.06.115.
[9]Watanabe M,Saito Y,Aonuma K,et al.Prediction of contrastinduced nephropathy by the serum creatinine level on the day following cardiac catheterization[J].J Cardiol,2016,68(5):412-418.DOI:10.1016/j.jjcc.2015.10.016.
[10]Quintavalle C,Anselmi CV,De Micco F,et al.Neutrophil gelatinase-associated lipocalin and contrast-induced acute kidney injury[J].Circ Cardiovasc Interv,2015,8(9):e002673.DOI:10.1161/CIRCINTERVENTIONS.115.002673.
[11]Franke RP,Jung F.Pathophysiology of the contrast media-induced nephropathy(CIN)in patients undergoing coronary interventions[J].Clin Hemorheol Microcirc,2013,53(1-2):143-153.DOI:10.3233/CH-2012-1582.
[12]Ye Z,Lu H,Guo W,et al.The effect of alprostadil on preventing contrast-induced nephropathy for percutaneous coronary intervention in diabetic patients:a systematic review and meta-analysis[J].Medicine(Baltimore),2016,95(46):e5306.DOI:10.1097/MD.0000000000005306.
[13]Li WH,Li DY,Qian WH,et al.Prevention of contrast-induced nephropathy with prostaglandin E1in high-risk patients undergoing percutaneous coronary intervention[J].Int Urol Nephrol,2014,46(4):781-786.DOI:10.1007/s11255-014-0674-5.
[14]Zhang JZ,Kang XJ,Gao Y,et al.Efficacy of alprostadil for preventing of contrast-induced nephropathy:a meta-analysis[J].Sci Rep,2017,7(1):1045.DOI:10.1038/s41598-017-01160-1.
[15]Wang J,Ai X,Li L,et al.Alprostadil protects type 2diabetes mellitus patients treated with metformin from contrastinduced nephropathy[J].Int Urol Nephrol,2017,49(11):2019-2026.DOI:10.1007/s11255-017-1639-2.
[16]Miao Y,Zhong Y,Yan H,et al.Alprostadil plays a protective role in contrast-induced nephropathy in the elderly[J].Int Urol Nephrol,2013,45(4):1179-1185.DOI:10.1007/s11255-013-0484-1.
[17]Liang M,Yang S,Fu N,et al.Efficacy of alprostadil in preventing contrast-induced nephropathy in patients undergoing percutaneous coronary intervention:a multicenter prospective randomized controlled trial[J].Catheter Cardiovasc Interv,2018,91(4):742-750.DOI:10.1002/ccd.27353.
[18]Shang W,Wang Z.The Update of NGAL in acute kidney injury[J].Curr Protein Pept Sci,2017,18(12):1211-1217.DOI:10.2174/1389203717666160909125004.
[19]Wang K,Duan CY,Wu J,et al.Predictive value of neutrophil gelatinase-associated lipocalin for contrast-induced acute kidney injury after cardiac catheterization:a meta-analysis[J].Can J Cardiol,2016,32(8):1033.e19-e29.DOI:10.1016/j.cjca.2015.09.011.