前列地尔预防对比剂诱导的急性肾损伤多中心研究

发布时间：2018-07-05 04:21

本文选题：对比剂诱导的急性肾损伤 + 前列地尔　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:探讨前列地尔对冠心病患者经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)术后对比剂诱导的急性肾损伤(contrast induced acute kidney injury,CIAKI)预防作用、并分析可能的作用机制、观察其用药安全性。方法:前瞻性连续入选2015年1月~2016年12月于天津市第一中心医院、天津市第四中心医院、天津市泰达国际心血管病医院、天津市胸科医院四个研究中心,拟行PCI术的冠心病患者共700例。入选患者被随机分为两组:前列地尔组(n=350)、对照组(n=350)。前列地尔组围手术期给予水化联合前列地尔治疗;对照组围手术期仅给予单纯水化治疗。通过比较PCI术前和术后72h,两组患者血尿素氮(Blood urea nitrogen,BUN)、肾小球滤过率(estimated glomerular filtration rate,eGFR)、血清肌酐(Serum creatinine,Scr)、中性粒细胞明胶酶相关脂质运载蛋白(Neutrophil gelatinase-associated lipid transport protein,NGAL)水平变化。探讨前列地尔对CIAKI是否具有预防作用,并通过比较两组患者PCI术前、术后72h的肿瘤坏死因子α(tumor necrosis factor,TNF-α)、超氧化物歧化酶(Superoxide dismutase,SOD)、还原型谷胱甘肽(glutathione,GSH)、白细胞介素-6(Interleukin-6,IL-6)等炎症及氧化应激因子的变化,探讨前列地尔肾脏保护机制,同时记录前列地尔组有无低血压、心脏及肾脏不良事件发生。结果:1.两组患者基线资料基本一致(P0.05)。2.PCI术前,两组患者的血液中eGFR、BUN、Scr、TNF-α、IL-6、SOD、NGAL及GSH水平,差异无统计学意义(P0.05)。3.前列地尔组共有8例患者发生CIAKI,发病率为2.3%;对照组共有28例患者发生CIAKI,发病率为8%,两组CIAKI发病率(2.3%vs 8%),差异有统计学意义(P0.05)。4.PCI术后72h,两组患者的血液中反映肾功能的BUN、Scr、eGFR水平与术前相比无明显变化,差异无统计学意义(P0.05)。5.与术前相比,PCI术后72h两组患者血液中NGAL、IL-6、SOD、TNF-α及GSH水平明显增高,差异有统计学意义(P0.05)。6.PCI术后72h,前列地尔组患者的血液中NGAL、IL-6及GSH水平较对照组明显降低,差异有统计学意义(P0.05)。7.前列地尔治疗组患者住院期间用药安全性良好。结论:1.围手术期前给予患者前列地尔治疗,能明显降低冠心病患者PCI术后CIAKI的发病率。2.前列地尔具有保护肾功能的作用。其机制可能与其抗炎症、抗氧化及扩张肾血管作用有关。3.前列地尔具有良好的安全性。
[Abstract]:Objective: to investigate the preventive effect of alprostadil on acute renal injury induced by (contrast induced acute kidney injuryn CIAKI after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Methods: prospective candidates were selected from January 2015 to December 2016 at Tianjin first Central Hospital, Tianjin fourth Central Hospital, Tianjin Taida International Cardiovascular Disease Hospital, Tianjin chest Hospital, and four research centers. There were 700 patients with coronary heart disease undergoing PCI. The patients were randomly divided into two groups: alprostadil group (n = 350) and control group (n = 350). The patients in the alprostadil group were treated with hydration combined with alprostadil during perioperative period, while the control group were only treated with pure hydration during the perioperative period. The changes of blood urea nitrogen (urea), glomerular filtration rate (estimated glomerular filtration), serum creatinine SCR (creatinine SCR) and neutrophil gelatinase-associated lipid transport protein (Neutrophil gelatinase-associated lipid transport) were compared between the two groups before and 72 hours after PCI. To investigate the preventive effect of alprostadil on CIAKI, and compare the two groups of patients before PCI. TNF- 伪, superoxide dismutase (SOD), glutathione (GSH), interleukin-6 (IL-6) and other inflammatory and oxidative stress factors were observed 72 hours after operation. At the same time, the adverse events of heart and kidney and hypotension were recorded in alprostadil group. The result is 1: 1. The baseline data of the two groups were basically the same (P0.05). 2. Before PCI, there was no significant difference (P0.05) between the two groups in the levels of eGFR- BUN-Scr-TNF- 伪 IL-6, SODNGAL and GSH (P0.05). There were 8 patients with CIAKI in the alprostadil group and 28 patients with CIAKI in the control group. The incidence of CIAKI was 8% in the control group. The difference was statistically significant (P0.05). 4. The renal function was reflected in the blood of the two groups at 72 hours after PCI. There was no significant change in the level of BUNA Scr-eGFR compared with that before operation. The difference was not statistically significant (P0.05). Compared with the patients before PCI 72 hours after PCI, the blood levels of NGALL IL-6 / SODN- 伪 and GSH in the two groups were significantly higher than those in the control group (P0.05). 6. The levels of NGALL IL-6 and GSH in the blood of the patients in the proprostadil group were significantly lower than those in the control group (P0.05) at 72 hours after PCI (P0.05). The safety of alprostadil treatment group was good during hospitalization. Conclusion 1. The incidence of CIAKI in patients with coronary heart disease after PCI was significantly decreased by the treatment of alprostadil before the perioperative period. Alprostadil can protect kidney function. Its mechanism may be related to its anti-inflammatory, anti-oxidation and dilatation of renal vessels. Prostadil has good safety.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5;R541.4

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