阿托伐他汀联合普罗布考对冠状动脉介入治疗术后造影剂肾病的预防作用
发布时间：2018-05-09 13:08
本文选题：阿托伐他汀 + 普罗布考 ； 参考：《中华高血压杂志》2017年07期
【摘要】：目的探讨阿托伐他汀联合普罗布考治疗对经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的预防作用、安全性及可能机制。方法入选2013年2月至2015年6月于天津市胸科医院心内科行择期PCI术的冠状动脉性心脏病(冠心病)患者共330例,按随机数字表法随机分为3组:常规剂量阿托伐他汀组(A组,n=110)、强化剂量阿托伐他汀组(B组,n=110)、常规剂量阿托伐他汀联合普罗布考组(C组,n=110)。A组:术前1d开始给予阿托伐他汀20mg,1次/晚;B组:术前1d开始给予阿托伐他汀40mg,1次/晚;C组:术前1d开始给予阿托伐他汀20mg,1次/晚和普罗布考250mg,3次/d。3组患者均于PCI术后4d开始仅给予阿托伐他汀20mg,1次/晚。收集3组患者的基本资料、造影剂用量,并记录PCI术前及术后72h的血清肌酐、血尿素氮、估算的肾小球滤过率(eGFR)、高敏C反应蛋白(hsCRP)、丙二醛、丙氨酸氨基转移酶(ALT)水平的变化。记录3组患者CIN发生情况、住院期间阿托伐他汀及普罗布考的不良反应。结果 3组患者术前基线资料差异无统计学意义(P0.05)。B组和C组CIN发生率低于A组(1.8%,2.7%比10.0%,均P0.05);B组与C组CIN发生率差异无统计学意义(P0.05)。PCI术后72h,A组患者的肌酐、尿素氮水平较术前升高,eGFR水平较术前下降(均P0.05);B组、C组患者的肌酐、尿素氮水平低于A组[(80.99±16.65),(81.79±17.96)比(93.30±20.97)μmol/L;(5.78±0.92),(6.05±1.29)比(6.18±1.08)mmol/L],eGFR水平高于A组[(78.80±26.04),(75.42±20.81)比(69.39±22.81)mL/(min·1.73m~2),均P0.05]。PCI术后,3组患者的hsCRP、丙二醛水平较术前升高(均P0.05);B组和C组患者的hsCRP、丙二醛水平低于A组。多因素Logistic回归分析显示强化他汀(OR=0.093,95%CI0.016~0.533,P=0.008)及他汀联合普罗布考(OR=0.252,95%CI 0.068~0.931,P=0.039)是CIN的保护因素;住院期间,3组患者均未出现明显肝损害、肌无力等不良事件。结论强化剂量阿托伐他汀及常规剂量阿托伐他汀联合普罗布考均能降低CIN的发生率,并且有良好的安全性,其机制可能与抑制炎症、氧化应激反应有关。
[Abstract]:Objective to investigate the preventive effect, safety and possible mechanism of Atto vastatin combined with probucol on contrast-agent nephropathy after percutaneous coronary intervention (PCI). Methods from February 2013 to June 2015, a total of 330 patients with coronary heart disease (CHD) underwent elective PCI operation in Department of Cardiology, Tianjin chest Hospital. According to the random digital table method, three groups were randomly divided into three groups: routine dose of Atto vastatin group (group A), group A (group A), intensive dose of Atto vastatin group (group B), group B (group B), routine dose of Atto vastatin combined with probucol group (group C) and group C (group A): Atto was given 1 day before operation. The patients in group B received 40 mg of Atto at 1 day before operation: 20 mg of Atto statin once per night on the first day of operation and only once a time of 20 mg / d of probucol 250 mg of probucol on the 4th day after PCI. The patients in group B received only 20 mg / d of Atto vastatin at the beginning of 4 days after PCI. The patients in group B received only 20 mg / d of Atto vastatin at the beginning of the first day of operation and only 20 mg / d of probucol at the beginning of 4 days after PCI. The changes of serum creatinine, blood urea nitrogen, estimated glomerular filtration rate (GFR), Gao Min C-reactive protein hsCRP, malondialdehyde (MDA) and alanine aminotransferase (alt) were recorded before and 72 hours after PCI. The incidence of CIN and the adverse reactions of Atto vastatin and probucol during hospitalization were recorded. Results there was no significant difference in preoperative baseline data among the three groups. The incidence of CIN in group B and group C was lower than that in group A (1.8% vs 10.0%). There was no significant difference in the incidence of CIN between group B and group C. The level of urea nitrogen was higher than that before operation and the level of eGFR was lower than that before operation (P 0.05). 灏跨礌姘按骞充綆浜嶢缁刐(80.99卤16.65),(81.79卤17.96)姣，
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