强化阿托伐他汀治疗对老年人冠心病介入治疗术后造影剂肾病的影响  

Effect of Intensive Dose Arvastatin on Preventive Contrast-induced Nephropathy in Elder with Coronary Heart Disease after Elective Percutaneous Coronary Intervention

作　　者：陈笑瑛[1] 徐建然[1] 胡海雷[1] 盛益[1] 陈岳维[1] 史习宝[1] 潘荣荣[1] 

机构地区：[1]温州医学院附属慈溪医院心血管内科,浙江省慈溪315300

出　　处：《中国基层医药》2012年第16期2411-2413,共3页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省慈溪市科技计划项目

摘　　要：目的 探讨强化剂量阿托伐他汀对老年冠心病（CHD）患者经皮冠状动脉介入治疗（PCI）术后造影剂肾病（CIN）的预防作用。方法 将100例年龄＞60岁的行冠脉介入治疗的CHD患者随机分为观察组和对照组,每组50例。在全部采用水化治疗基础上,观察组给予强化剂量阿托伐他汀,对照组给予常规剂量阿托伐他汀。术前、术后测定血清肌酐（Scr）、血β2-微球蛋白（β2-MG）、肝功能等指标,按Cochcroft-Gault公式计算内生肌酐清除率（Ccr）;记录住院期间和随访期间30 d内主要不良心脏事件（MACE）发生率及肝毒性和肌毒性发生情况。结果 术后第1、3天观察组Ccr显著高于对照组［（73.12±16.89）ml/min比（63.89±18.42）ml/min,P=0.036］、［（65.32±13.46）ml/min比（55.63±15.47）ml/min,P=0.021］;术后第1、2、3 d观察组β2-MG显著低于对照组［（2.44±0.42）ml/min比（2.69±0.63）ml/min,P=0.009］、［（2.52±0.46）ml/min比（2.81±0.63）ml/min,P=0.011］、［（2.37±0.43）ml/min比（2.54±0.65）ml/min,P=0.021］;观察组CIN发生率显著低于对照组（分别为6%和24%,P=0.012）;随访30 d内,共14例（14%）患者发生MACE,其中观察组3例（6%）,对照组11例（22%）（χ2=5.316,P=0.021）;两组均无肌毒性和肝毒性发生。结论 PCI术前服用强化剂量阿托伐他汀对老年患者CIN的发生可能有更好的预防作用,且较为安全。Objective To investigate the effect of intensive dose atorvastatin on preventive contrast-induced nephropathy （CIN） in elder with coronary heart disease （CHD） after elective percutaneous coronary intervention（PCI）.Methods 110 subjects older than 60 who received elective PCI,were randomly divided into intensive dose atorvastatin group （the study group,n=50） and conventional treatment group （the control group,n=50）.On the basis of the hydration therapy,the study group received atorvastatin and the control group received atorvastatin.Scr、β2-MG and liver function were checked for evidence of tubular or glomerular damage before and after elective PCI were compared between the two groups.Ccr was calculated according to Cockcroft-Gault formula;The incidence of the major adverse cardiovascular events （MACE） and cytotoxicity and hepatotoxicity of rosuvastation were respectively recorded in 30 days follow-up period.Results Ccr in the study group was significantly higher than that in the control group at day 1［（73.12±16.89）ml/min vs （63.89±18.42）ml/min,P=0.036］,day 2［（65.32±13.46）ml/min vs （55.63±15.47）ml/min,P=0.021］;Blood β2-M in the study group was significantly lower than that in the control group at day 1［（2.44±0.42）ml/min vs （2.69±0.63）ml/min,P=0.009］,day 3（2.52±0.46）ml/min vs （2.81±0.63）ml/min,P=0.011］,day 3［（2.37±0.43）ml/min vs （2.54±0.65）ml/min,P=0.021］.The incidence of CIN was lower in the study group than that in the control group（6% vs 24%,P=0.012）.During 30days clinical follow-up,the incidence of the MACE in the control group was more than the study group （χ2=5.316,P=0.021）.There was no significant difference between the two groups for the cytotoxicity and hepatotoxicity.Conclusion High dose atorvastatin may be more efficient in prevention CIN in elder before elective PCI and this higher dose may be safe to the elder.

关 键 词：阿托伐他汀 冠状动脉疾病 造影剂肾病 

分 类 号：R541.4[医药卫生—心血管疾病]