不同剂量阿托伐他汀改善对比剂所致肾功能损害  

Effect of different doses of Atorvastatin in contrast-induced nephropathy

作　　者：俞登及[1] 苏津自[1] 陈光铃[2] 蔡文钦[1] 晋学庆[1] 柴大军[1] 

机构地区：[1]福建医科大学附属第一医院心内科,福建福州350005 [2]福建医科大学附属闽东医院心内科,福建福安355000

出　　处：《中国介入影像与治疗学》2010年第5期520-524,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：福建省自然基金面上项目(2010J01150)

摘　　要：目的探讨不同剂量阿托伐他汀对急性冠状动脉综合征(ACS)患者接受经皮冠状动脉介入术(PCI)因对比剂引起的肾功能损害的缓解作用及其可能机制。方法 80例接受PCI的ACS患者随机分为两组,术前2～3天每晚顿服阿托伐他汀40mg(40mg他汀组,n=40)或20mg(20mg他汀组,n=40)。分别于术前8h、术后第1天、第2天测定血超敏C反应蛋白(hsCRP)、胱抑素C(CysC)、血清肌酐(Scr)、血尿素氮(BUN),检测尿α1-微球蛋白(α1-MG)、转铁蛋白(TRF)、微量白蛋白(mALB),计算肌酐清除率(Ccr)和肾小球滤过率(GFR),并进行统计学分析。结果①PCI术后,40mg他汀组中未发现对比剂肾病(CIN)病例,20mg他汀组中1例患者发生CIN(2.50%)。②与术前相比,术后第1天两组患者的α1-MG、Scr及CysC均明显升高(P均<0.05),Ccr及GFR明显降低(P均<0.05);与术后第一天比,术后第二天两组患者的α1-MG、Scr及CysC均明显降低(P均<0.05),而Ccr及GFR明显升高(P均<0.05)。③与术前相比,两组患者术后第1天hsCRP均明显升高(P均<0.05);与术前第1天相比,术后第2天hsCRP均无明显变化(P均<0.05)。④组间相比,术前及术后两组患者BUN、TRF、mALB、Scr、Ccr、CysC、GFR及hsCRP的差异均无统计学意义(P均>0.05)。结论 PCI术前2～3天服用阿托伐他汀可有效缓解对比剂所致肾功能损害,其作用机制可能与减轻炎症反应、改善血管内皮功能有关。Objective To observe the mitigative effect and mechanism of different doses of Atorvastatin on renal impairment caused by contrast agent in patients with acute coronary syndrome（ACS）who underwent percutaneous coronary intervention（PCI）.Methods A total of 80 ACS patients underwent PCI were randomly divided into 20 mg Atorvastatin group（n=40）and 40 mg Atorvastatin group.Patients took 40 mg or 20 mg Atorvastatin daily 2 or 3 days before PCI.The levels of high-sensitivity CRP（hsCRP）,cystain C（CysC）,serum creatinine（Scr）,blood urea nitrogen（BUN）,as well as urinary α1-microglobulin（α1-MG）,transferring（TRF）and microalbumin（mALB）were detected at 8 h before and 1 and 2 days after PCI,respectively.The creatinine clearance rate（Ccr）and glomerular filtration rate（GFR）were calculated,and the statistical analysis was performed.Results ①None of CIN patient was not found in 40 mg Atorvastatin group,while the incidence of CIN was 2.50% in 20 mg Atorvastatin group.②α1-MG,Scr and CysC were significantly increased in both 2 groups at 1 day after PCI（all P0.05）,while Ccr and GFR were significantly decreased（both P0.05）.α1-MG and CysC of two groups significantly decreased 2 days after PCI（all P0.05）,as well as Ccr and GFR were significantly increased at the same time（both P0.05）.③One day after PCI,the hsCRP levels of two groups were significantly higher than those of preoperation（all P0.05）.No statistical difference was found between the hsCRP level at 1 day and 2 days after PCI in both two groups.④There was no significant difference of BUN,TRF,mALB,Scr,Ccr,CysC,GFR and hsCRP between two groups（all P0.05）.Conclusion Pretreatment with Atorvastatin 2 to 3 days before PCI can effectively alleviate the renal impairment caused by contrast agent.Its mechanism may relate to the relief of anti-inflammation and the improvement of vascular endothelial function.

关 键 词：阿托伐他汀 对比剂肾病 超敏C反应蛋白 

分 类 号：R595.3[医药卫生—内科学]