辅酶Q10片联合曲美他嗪片用于冠心病合并肾功能不全患者的临床研究
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摘要
目的观察辅酶Q10片(Co Q10)联合曲美他嗪片(TMZ)用于冠心病合并肾功能不全患者择期心导管术后对比剂肾病(CIN)的预防作用及安全性。方法将150例择期进行心导管术冠心病合并肾功能不全患者随机分为对照组和试验组,每组75例。对照组不予以任何处置;试验组予以Co Q10每次10 mg,tid,口服+TMZ每次20 mg,tid,从心导管术术前2 d开始给药持续至术后3 d。比较2组患者的血清肌酸酐(SCr)、肾小球率过滤(e GFR)和胱抑素-C(Cys-C)水平,对比剂肾病(CIN)发生率,以及药物不良反应的发生情况。结果心导管术后48 h,试验组和对照组的SCr分别为(129. 86±21. 75)和(139. 52±20. 21)μmol·L~(-1),Cys-C分别为(1. 95±0. 43)和(2. 13±0. 35) mg·L~(-1),e GFR分别为(46. 30±5. 69)和(43. 14±5. 81) mL·min~(-1)·1. 73 m~(-2),CIN发病率分别为6. 67%(5例/75例)和21. 33%(16例/75例),差异均有统计学意义(均P <0. 05)。2组患者治疗期间均未发生药物不良反应。结论 Co Q10联合TMZ对冠心病合并肾功能不全患者择期心导管术后CIN的发生有一定的预防作用,且安全性较高。
Objective To observe the preventive effect and safety of coenzyme Q10( CoQ10) combined with trimetazidine( TMZ) on contrast-induced nephropathy( CIN) in patients with renal insufficiency undergoing elective cardiac catheterization. Methods A total of 150 consecutive patients with renal insufficiency undergoing elective cardiac catheterization were randomly divided into treatment group( n = 75) and control group( n = 75). Control group was not given any treatment. Treatment group was given CoQ10 10 mg per time,tid,orally + TMZ 20 mg per time,tid,orally,from 2 days before to 3 days after procedure. The levels of serum creatinine( SCr),glomerular filtration rate( eGFR) and cystatin C( Cys-C),the incidence of CIN,and adverse drug reactions were compared between two groups. Results At 48 h after cardiac catheterization,the main indexes of treatment and control groups were compared:SCr were( 129. 86 ± 21. 75) and( 139. 52 ± 20. 21) μmol·L~(-1),Cys-C were( 1. 95 ± 0. 43) and( 2. 13 ± 0. 35) mg · L~(-1),eGFR were( 46. 30 ± 5. 69) and( 43. 14 ± 5. 81) mL·min~(-1)·1. 73 m~(-2),incidencesof CIN were 6. 67%( 5 cases/75 cases) and 21. 33%( 16 cases/75 cases),the differences were statistically significant( all P < 0. 05). There were no adverse drug reactions during the treatment of the two groups. Conclusion CoQ10 combined with TMZ is effective and safe for prevention of CIN in patients with renal insufficiency undergoing elective cardiac catheterization.
Objective To observe the preventive effect and safety of coenzyme Q10( CoQ10) combined with trimetazidine( TMZ) on contrast-induced nephropathy( CIN) in patients with renal insufficiency undergoing elective cardiac catheterization. Methods A total of 150 consecutive patients with renal insufficiency undergoing elective cardiac catheterization were randomly divided into treatment group( n = 75) and control group( n = 75). Control group was not given any treatment. Treatment group was given CoQ10 10 mg per time,tid,orally + TMZ 20 mg per time,tid,orally,from 2 days before to 3 days after procedure. The levels of serum creatinine( SCr),glomerular filtration rate( eGFR) and cystatin C( Cys-C),the incidence of CIN,and adverse drug reactions were compared between two groups. Results At 48 h after cardiac catheterization,the main indexes of treatment and control groups were compared:SCr were( 129. 86 ± 21. 75) and( 139. 52 ± 20. 21) μmol·L~(-1),Cys-C were( 1. 95 ± 0. 43) and( 2. 13 ± 0. 35) mg · L~(-1),eGFR were( 46. 30 ± 5. 69) and( 43. 14 ± 5. 81) mL·min~(-1)·1. 73 m~(-2),incidencesof CIN were 6. 67%( 5 cases/75 cases) and 21. 33%( 16 cases/75 cases),the differences were statistically significant( all P < 0. 05). There were no adverse drug reactions during the treatment of the two groups. Conclusion CoQ10 combined with TMZ is effective and safe for prevention of CIN in patients with renal insufficiency undergoing elective cardiac catheterization.
引文
[1] MCCULLOUGH P A,CHOI J P,FEGHALI G A,et al. Contrastinduced acute kidney injury[J]. J Am Coll Cardiol,2016,68(13):1465-1473.
[2] VANMASSENHOVE J,KIELSTEIN J,JRRES A,et al. Management of patients at risk of acute kidney injury[J]. Lancet,2017,389(10084):2139-2151.
[3] ONBASILI AO,YENICERIGLU Y,AGAOGLU P,et al. Trimetazidine in the prevention of contrast-induced nephropathy after coronary procedures[J]. Heart,2007,93(6):698-702.
[4] LEE B J,TSENG Y F,YEN C H,et al. Effects of coenzyme Q10supplementation(300 mg/day)on antioxidation and anti-inflammation in coronary artery disease patients during statins therapy:a randomized,placebo-controlled trial[J]. Nutr J,2013,12(1):142.
[5]葛均波,徐永健.内科学[M]. 8版.北京:人民卫生出版社,2013:227.
[6] BRIGUORI C,DONNARUMMA E,QUINTAVALLE C,et al. Contrast-induced acute kidney injury:potential new strategies[J].Curr Opin Nephrol Hypertens,2015,24(2):145-153.
[7] SUBRAMANIAM R M,SUAREZ-CUERVO C,WILSON R F,et al. Effectiveness of prevention strategies for contrast-induced nephropathy:A systematic review and meta-analysis[J]. Ann Intern Med,2016,164(6):406-416.
[8] MAMOULAKIS C,TSAROUHAS K,FRAGKIADOULAKI I,et al.Contrast-induced nephropathy:Basic concepts,pathophysiological implications and prevention strategies[J/OL]. Pharmacol Ther,2017,180:99-112. 2017-06-19[2018-05-07]. https://linkinghub. elsevier. com/retrieve/pii/S0163-7258(17)30157-2.
[2] VANMASSENHOVE J,KIELSTEIN J,JRRES A,et al. Management of patients at risk of acute kidney injury[J]. Lancet,2017,389(10084):2139-2151.
[3] ONBASILI AO,YENICERIGLU Y,AGAOGLU P,et al. Trimetazidine in the prevention of contrast-induced nephropathy after coronary procedures[J]. Heart,2007,93(6):698-702.
[4] LEE B J,TSENG Y F,YEN C H,et al. Effects of coenzyme Q10supplementation(300 mg/day)on antioxidation and anti-inflammation in coronary artery disease patients during statins therapy:a randomized,placebo-controlled trial[J]. Nutr J,2013,12(1):142.
[5]葛均波,徐永健.内科学[M]. 8版.北京:人民卫生出版社,2013:227.
[6] BRIGUORI C,DONNARUMMA E,QUINTAVALLE C,et al. Contrast-induced acute kidney injury:potential new strategies[J].Curr Opin Nephrol Hypertens,2015,24(2):145-153.
[7] SUBRAMANIAM R M,SUAREZ-CUERVO C,WILSON R F,et al. Effectiveness of prevention strategies for contrast-induced nephropathy:A systematic review and meta-analysis[J]. Ann Intern Med,2016,164(6):406-416.
[8] MAMOULAKIS C,TSAROUHAS K,FRAGKIADOULAKI I,et al.Contrast-induced nephropathy:Basic concepts,pathophysiological implications and prevention strategies[J/OL]. Pharmacol Ther,2017,180:99-112. 2017-06-19[2018-05-07]. https://linkinghub. elsevier. com/retrieve/pii/S0163-7258(17)30157-2.