强化阿托伐他汀治疗在老年肾功能不全患者PCI术后对比剂肾病预防中的作用

发布时间：2018-03-12 19:00

本文选题：阿托伐他汀　切入点：对比剂肾病　出处：《中国老年学杂志》2017年11期 　论文类型：期刊论文

【摘要】：目的探讨经皮冠状动脉介入治疗(PCI)术前强化阿托伐他汀治疗对老年冠心病合并肾功能不全的患者行PCI术后对比剂肾病(CIN)的预防作用及安全性问题。方法择期行PCI术的老年冠心病合并肾功能不全患者250例,随机分成强化阿托伐他汀组(强化组)和常规阿托伐他汀组(常规组)各125例。两组患者在水化的基础上在PCI术前3 d,分别给予阿托伐他汀40 mg/d和10 mg/d口服治疗。观察两组PCI术前及术后72 h血清尿素氮(BUN)、血清肌酐(Scr)、肌酐清除率(Ccr)、肾小球滤过率(eGFR)、β2微球蛋白(β2-MG)、超敏C-反应蛋白hs-(CRP)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、丙氨酸氨基转移酶(ALT)的变化,记录两组CIN的发病率、住院中阿托伐他汀的不良反应。结果 (1)强化组125例患者,发生CIN3例(2.4%);常规组125例患者,发生CIN12例(9.6%),两组CIN发病率差异显著(χ~2=5.75,P0.05)。多元Logistic回归分析结果亦表明强化阿托伐他汀治疗是CIN的保护因素(OR=0.079,95%CI 0.009~0.725,P=0.025)。(2)强化组与常规组的PCI术前血BUN、Scr、Ccr、eGFR、β2-MG、hs-CRP、IL-6、TNF-α、ALT等差异均无统计学意义(P0.05)。而PCI术后72 h,两组β2-MG、hs-CRP、IL-6、TNF-α较PCI术前增高;Ccr、eGFR较PCI术前降低(P0.05)。(3)PCI术后72 h,强化组β2-MG、hs-CRP、IL-6、TNF-α的水平低于常规组;Ccr、eGFR则高于常规组(P0.05)。(4)两组PCI术后72 h ALT较PCI术前未见明显的升高(P0.05),两组均未出现阿托伐他汀不良药物反应。结论强化阿托伐他汀治疗对于减少老年冠心病合并肾功能不全患者PCI术后CIN发病率具有一定的益处,具有良好的安全性,其机制可能与他汀抗炎症作用因素有关。
[Abstract]:Objective to investigate the preventive effect and safety of intensive Atto vastatin before percutaneous coronary intervention (PCI) in elderly patients with coronary heart disease complicated with renal insufficiency after PCI. Two hundred and fifty elderly patients with coronary heart disease complicated with renal insufficiency, Two groups were randomly divided into two groups: intensive Atto vastatin group (fortified group) and routine Atto vastatin group (conventional group). Two groups of patients were treated orally with Atto vastatin for 40 mg/d and 10 mg/d on the basis of hydration 3 days before PCI, respectively. Serum urea nitrogen bun (bun), creatinine creatinine (creatinine), creatinine clearance (CCR), glomerular filtration rate (GFR), 尾 2 microglobulin (尾 2 MGN), interleukin-6 (IL 6), tumor necrosis factor TNF- 伪 (TNF- 伪), alanine aminotransferase (alt) were observed before and 72 hours after PCI in the two groups. The incidence of CIN in two groups and the adverse reaction of Atto vastatin in hospital were recorded. Results 1) in the strengthening group, there were 2. 4% CIN3 cases, 125 cases in the routine group, 125 cases in the routine group, There was a significant difference in the incidence of CIN12 between the two groups (蠂 2 / 5.75 / P0.05). The results of multiple Logistic regression analysis also showed that enhanced Atto vastatin therapy was a protective factor for CIN. There was no significant difference in serum BUNScrcrcr, 尾 2-MGUhs-CRPIL-6TNF- 伪 alt between the enhanced group and the routine group (P 0.05). At 72 hours after PCI, the levels of 尾 2-MGG hs-CRPnIL-6 TNF- 伪 in both groups were significantly lower than those in PCI patients. The levels of 尾 2-MGG hs-CRPhs-CRPIL-6 TNF- 伪 in the enhanced group were significantly lower than those in the conventional group at 72 h after PCI compared with those in the PCI group. Both groups had no significant increase in the ALT at 72 h after PCI compared with the PCI group. Both groups had no significant increase in ALT at 72 h after PCI operation. The level of TNF- 伪 in the enhancement group was significantly lower than that in the conventional group at 72 h after PCI operation. The level of TNF- 伪 in both groups was significantly higher than that in the control group at 72 h after PCI operation. The level of TNF- 伪 in both groups was higher than that in the conventional group. Conclusion intensive Atto vastatin therapy can reduce the incidence of CIN after PCI in elderly patients with coronary heart disease and renal insufficiency. It has good safety and its mechanism may be related to the anti-inflammatory factors of statins.
【作者单位】：天津市胸科医院心内科;
【基金】：天津市卫生局科技攻关项目(No.10KG122)
【分类号】：R692

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