强化他汀治疗对急性心肌梗死患者PCI术后血清白介素18、胱抑素C及肾功能的影响

发布时间：2018-03-02 23:24

本文选题：阿托伐他汀　切入点：造影剂肾病　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：背景:近年来,急性心肌梗死(Acute myocardial infarction,AMI)的发病率呈逐年上升趋势,成为严重威胁人类健康和生命的常见病及多发病。急诊经皮冠状动脉介入治疗(Percuntaneous coronary intervention,PCI)是AMI最重要的治疗措施之一。然而,随着介入诊疗的普及和发展,造影剂在临床中的使用也逐渐增多,造影剂肾病(Contrast-induced nephropathy,CIN)作为介入诊疗术后常见的并发症,成为介入医师面临的难题。目前CIN尚无有效的治疗措施,因此如何预防CIN发生尤为关键。目前许多证据表明,他汀类药物可通过促进CIN发展过程中的多种因素减低CIN发病率。然而,他汀类药物的肾脏保护机制尚不明确。目的:评估强化阿托伐他汀对急性心肌梗死急诊PCI术后肾功能,白细胞介素-18及胱抑素-C的影响,并分析其可能机制。方法:入选2016年1月至2016年10月于遵义医学院附属医院行急诊经皮冠脉介入治疗的急性ST段抬高型心肌梗死患者。分组:(1)按术前Scr水平分为术前Scr正常组(A)(SCr≤109umol/L)、术前Scr轻度升高组(B)(SCr 110~265.2umol/L)。(2)根据术后分阿托伐他汀剂量分为常规组:常规给予阿托伐他汀40mg qd;强化组阿托伐他汀80mg qd,分别于术前、术后第1、2、3天检测Scr、Cys-C、IL-18。结果:1.A组与B组术前基本临床资料,包括年龄、性别、体重、既往疾病史、血脂及术中造影剂使用量等基线指标无明显统计学差异(P0.05)。2.术前A组Cys-C水平低于B组[(0.97±0.25)mg/L vs(1.88±0.26)mg/L,P0.05],术前A组IL-18水平低于B组[(96.7±27.22)pg/ml vs(215.8±30.33)pg/ml,P0.05]。3.两组术后肾功能变化:A组患者总体Scr、Cys-C水平术后与术前比较P0.05。A组中强化组术后Scr升高水平低于常规组,P0.05。A组中强化组术后Cys-C升高水平低于常规组,P0.05。B组患者总体Scr、Cys-C水平术后与术前比较P0.05。B组中强化组术后Scr升高水平低于常规组,P0.05。B组中强化组术后Cys-C升高水平低于常规组,P0.05。4.术后炎症介质指标变化:A组患者总体IL-18水平术后与术前比较升高,P0.05。A组患者强化组IL-18升高水平显著低于常规组,P0.05。B组患者总体IL-18水平术后与术前比较升高,P0.05。B组患者强化组IL-18升高水平显著低于常规组,P0.05。结论:强化阿托伐他汀治疗对急性心肌梗死急诊PCI术后的CIN可能具有一定的保护作用,其机制可能与减轻炎症反应有关。
[Abstract]:Background: in recent years, the incidence of acute myocardial infarction Amis has been increasing year by year. Emergency percutaneous coronary intervention (PCI) is one of the most important treatment measures for AMI. However, with the popularization and development of interventional diagnosis and treatment, emergency percutaneous coronary intervention (PCI) is one of the most important treatment measures for AMI. Contrast agent Contrast-induced nephropathycin (Contrast-induced nephropathycin), as a common complication after interventional therapy, has become a difficult problem for interventional physicians. At present, there is no effective treatment for CIN. Therefore, how to prevent the occurrence of CIN is particularly critical. There is a lot of evidence that statins can reduce the incidence of CIN by promoting a variety of factors in the development of CIN. However, Objective: to evaluate the effects of enhanced Atto vastatin on renal function, interleukin-18 and cystatin C after PCI in patients with acute myocardial infarction. Methods: patients with acute ST-segment elevation myocardial infarction who were treated with emergency percutaneous coronary intervention from January 2016 to October 2016 at the affiliated Hospital of Zunyi Medical College were selected. The patients were divided into two groups according to the preoperative Scr level. The normal Scr group was divided into two groups according to the postoperative dose of Atto vastatin: Atto vastatin 40 mg QD, the enhanced group Atto vastatin 80 mg QD, respectively. Results the basic clinical data including age, sex, body weight, history of disease, and basic clinical data of group B and group A were measured on the 1st and 2nd day after operation. There was no significant difference in baseline indexes such as blood lipids and intraoperative contrast media usage. The level of Cys-C in group A was lower than that in group B [0.97 卤0.25 mg / L vs(1.88 卤0.26 mg / L P 0.05], and IL-18 level in group A was lower than that in group B [96.7 卤27.22 PG / ml vs(215.8 卤30.33 mg / ml P 0.05]. The level of postoperative Scr in P0.05.A group was lower than that in P0.05.A group, and the level of postoperative Cys-C in P0.05.A group was lower than that in P0.05.B group. The level of Scr in group P0.05.B was higher than that in group P0.05.B before operation. The level of Cys-C in the enhancement group was lower than that in the routine group (P0.05.B). The change of inflammatory mediators index after operation was higher than that in the normal group (P 0.05.A group). The total IL-18 level in group A was significantly higher than that in group P0.05.A after operation. The level of IL-18 in group A was significantly lower than that in group P0.05.A after operation. The level of total IL-18 in P0.05.B group was significantly lower than that in the routine group P0.05.B group. Conclusion: intensive Atto vastatin therapy may have a significant effect on CIN after acute myocardial infarction emergency PCI operation in patients with P0.05.B.Conclusion: the level of total IL-18 in group P0.05.B is significantly lower than that in group P0.05.B. A certain protective effect, The mechanism may be related to the alleviation of inflammation.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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