高敏C反应蛋白水平与阿托伐他汀对急性冠状动脉综合征患者对比剂所致肾功能损害影响的关系  

Association between high sensitivity C-reactive protein and contrast induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention： impact of atorvastatin

作　　者：苏津自[1] 薛艳[1] 蔡文钦[1] 黄群英[1] 柴大军[1] 陈光铃[2] 王芳兵[1] 陈秀平[1] 张都生[1] 

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

出　　处：《中华心血管病杂志》2011年第9期807-811,共5页Chinese Journal of Cardiology

基　　金：福建省自然科学基金（2010J01150）

摘　　要：目的研究冠状动脉介入术前高敏C反应蛋白（hs-CRP）水平对急性冠状动脉综合征（Acs）患者术后肾功能改变的影响及阿托伐他汀的干预作用。方法270例ACS患者根据术前hs—CRP值分为3组：hs．CRP升高组（hs-CRP≥3mg/L，n=176）、hs—CRP轻度升高组（hs．CRP1—3mg／L，n=60）和hs—CRP正常组（hs—CRP〈1mg／L，n=34）。根据术前阿托伐他汀的用量，将176例hs—CRP升高组患者进一步分为阿托伐他汀10mg组（n=49）、20mg组（n=66）和40mg组（n=61）。所有患者于术前、术后第1天、术后第2天分别测定血清肌酐（Set）、尿素氮（BUN）、胱抑素c（CysC）及hs—CRP，根据Ser计算出肌酐清除率（CCr），据CysC计算肾小球滤过率（GFR）。以术后发生对比剂急性肾损害（CI-AKI）为因变量，采用多因素logistic逐步回归分析肾功能损害的影响因素。结果（1）与hs—CRP正常组相比，hs—CRP升高组术后Cysc和Scr较高，而GFIt较低（P〈O．05），hs-CRP轻度升高组术后CysC较高、GFR较低（P〈0．05），而Ser差异无统计学意义。（2）270例患者中106例发生CI—AKI，总发生率39．26％。hs—CRP升高组76例（43．18％），hs—CRP轻度升高组23例（38．33％）；hs．CRP正常组7例（20．59％），3组间CI-AKI发生率差异有统计学意义（X。=6．13，P〈0．05）。（3）在hs．CRP升高患者，40mg阿托伐他汀组术后GFR高于10mg与20mg阿托伐他汀组（P〈0．05），CysC与hs．CRP低于10mg阿托伐他汀组（P〈0．05），20mg阿托伐他汀组术后hs-CRP也低于10mg阿托伐他汀组（P〈O．05）。（4）logistic回归结果显示，使用高剂量阿托伐他汀是术后发生CI-AK1的保护因素（20mg阿托伐他汀：DR=0．15，95％CI：0．06～0．33，P=0．001；40mg阿托伐他汀：OR=0．10，95％c，：0．04—0．23，P=0．001），而术前高水平hs—CRP（OR=2．06，95％CI：1．01-4．23，P=0．048）、糖尿病（OR=10�Objective To observe the association between preprocedural high sensitivity C-reactiveprotein （hs-CRP） level and incidence of contrast induced acute kidney injury （CI-AKI） in acute coronary syndrome （ACS） patients undergoing percutaneous coronary intervention （PCI） and the impact of atorvastatin pretreatment on CI-AKI. Methods According to the level of preprocedural hs-CRP, 270 ACS patients were divided into three groups： high hs-CRP group （hs-CRP 3mg/L, n = 176）, moderate hs- CRP group （hs-CRP 1 - 3 rag/L, n = 60） and normal hs-CRP group （ hs-CRP 〈 1 mg/L, n = 34）. According to the dosage of preprocedural atorvastatin, the high hs-CRP group was further divided into 10 mg group （ n = 49）, 20 mg group （ n = 66） and 40 mg group （ n = 61 ）. Serum creatinine （Scr）, blood urea nitrogen （BUN）, cystatin C （Cys C）, hs-CRP were measured at before and 24 hours, 48 hours after PCI. CCr and GFR were calculated according to Scr and Cys C. Risk factors for CI-AKI were determined by multivariate logistic regression analysis. Results （1） Cys C was significantly increased and GFR after PCI significantly reduced in high and moderate hs-CRP groups compared with normal hs-CRP group （P 〈 O. 05）. （2） Incidence of CI-AKI was 43.18%, 38.33% , 20. 59% in high, moderate and normal hs-CRP groups, respectively （P 〈 0.05 ）. （3） In high hs-CRP group, postprocedural GFR was significantly higher while postprocedural Cys C and hs-CRP were significantly lower in 40 mg statin subgroup than 10 mg and 20 mg statin subgroups （P 〈 O. 05）, similar trends were documented when comparing 20 mg statin subgroup with 10 mg statin subgroup （P 〈 0.05 ）. （4） Multivariate logistic regression analysis showed that pretreatment with high dose atorvastatin was a protective factor for post CI-AKI （20 mg atorvastatin： OR =0. 15, 95% CI 0.06 - 0. 33, P = 0. 001 ; 40 mg atorvastatin ： OR = 0. 10, 95% CI 0. 04 - 0. 23, P = 0. 001 ）, while high levels of preprocedural

关 键 词：冠状动脉疾病 降血脂药 血管成形术 经腔 经皮冠状动脉 造影剂 肾功能不全 

分 类 号：R541[医药卫生—心血管疾病]