他汀类药物对急性心肌梗死患者直接冠状动脉介入治疗后对比剂肾病的预防作用  

Statins for prevention of contrast-induced nephropathy in patients with acute myocardial infarction performed primary percutaneous coronary intervention

作　　者：徐验[1] 衣为民[1] 龙娟[1] 罗颖[1] 张怡清[1] 胡伟[1] 郭文玉[1] 

机构地区：[1]深圳市孙逸仙心血管医院心内科,广东深圳518020

出　　处：《岭南心血管病杂志》2012年第2期140-143,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨急性心肌梗死(acute myocardial infarction,AMI)患者行直接经皮冠状动脉介入(percutaneouscoronary intervention,PCI)治疗前,应用他汀类药物对于对比剂肾病(contrast-induced nephropathy,CIN)的预防作用。方法回顾性分析186例行直接PCI治疗的急性ST段抬高AMI患者的临床资料,根据入院前是否接受他汀类药物治疗,分为他汀组(42例)和非他汀组(144例),收集其PCI治疗前和治疗后48～72 h内的血清肌酐浓度,计算内生肌酐清除率。结果186例患者中34例发生CIN,CIN发生率为18.3%;他汀组CIN发生率显著低于非他汀组,差异有统计学意义(7.1%vs.21.5%,P<0.05)。他汀组术后血清肌酐浓度明显低于非他汀组,差异有统计学意义[(90.3±26.0)μmol/L vs.(101.5±28.4)μmol/L,P<0.05]。术后他汀组内生肌酐清除率明显高于非他汀组,差异有统计学意义[(72.5±21.1)mL/min vs.(63.9±18.2)mL/min,P<0.05]。多因素回归分析显示,PCI治疗前应用他汀类药物(OR 0.48,95%CI 0.11～0.89,P<0.05)和肾功能不全(基线内生肌酐清除率<60 mL/min)、使用主动脉内球囊反搏治疗、心源性休克是CIN的独立预测因素。结论急性AMI行直接PCI治疗的患者,术前应用他汀类药物治疗能保护肾功能,降低CIN的发生率,提示术前他汀类药物预处理可能具有预防CIN的作用。Objectives To investigate the efficacy of pretreatment with statins for prevention of contrast-induced nephropathy（CIN） in patients with acute myocardial infarction（AMI） who underwent primary percutaneous coronary intervention（PCI）.Methods Clinical data of 186 patients with acute ST-segment elevation AMI who underwent primary PCI were retrospectively analyzed.Forty two patients had chronically received statins before admission（statins group） and 144 had not（no-statins group）.Serum concentration of creatinine（Scr） was measured before and in 48-72hrs after PCI.Creatinine clearance（Ccr） was calculated.Results Of all 186 patients,34 patients（18.3%） developed CIN.There was a significantly lower incidence of CIN in statins group compared with no-statins group（7.1% vs.21.5%,P0.05）.Also,post-procedural Scr was lower and Ccr was higher in statins group than those in no-statins group,which was of statistical significance [（90.3±26.0）μmol/L vs.（101.5±28.4）μmol/L,P0.05;（72.5±21.1）mL/min vs.（63.9±18.2）mL/min,P0.05].Multivariate analysis revealed that statin pretreatment before PCI（OR 0.48,95%CI 0.11 ～0.89,P0.05） was an independent predictor of CIN along with pre-existing renal insufficiency（baseline Ccr60 mL/min）,implantation of intra-aortic balloon bump and cardiogenic shock.Conclusions Pretreatment with statins can reduce the incidence of CIN by protecting renal function of patients with AMI performed primary PCI,which indicates that preprocedural statin therapy may prevent CIN.

关 键 词：心肌梗死 他汀类药物 造影剂 肾功能衰竭 急性 对比剂肾病 

分 类 号：R542.22[医药卫生—心血管疾病]