苯磺酸氨氯地平对老年冠心病患者造影剂相关肾损害的保护作用  

Protective effect of amlodipine against contrast agent-induced renal injury in elderly patients with coronary heart disease

作　　者：惠海鹏[1] 李开亮[1] 李振彪[2] 汪晶晶[3] 高萌[1] 韩学美[4] 

机构地区：[1]解放军总医院南楼心一科,北京100853 [2]解放军总后卫生部药品仪器检验所器检办,北京100071 [3]解放军总医院心内科,北京100853 [4]解放军总医院南楼急诊科,北京100853

出　　处：《南方医科大学学报》2012年第11期1580-1583,共4页Journal of Southern Medical University

基　　金：全军医学科技"十二五"科研项目重点项目(BWS11J054)

摘　　要：目的探讨苯磺酸氨氯地平是否对老年冠心病患者造影剂相关肾损害具有保护作用。方法本研究人选的年龄在60岁(含)以上的老年冠心病患者随机分为对照组和治疗组。两组在水化基础上,分别于应用造影剂前7d和后2d口服安慰剂或苯磺酸氨氯地平。比较两组造影后24、48 h及5d时血胱抑素C、尿素氮、肌肝、肌酐清除率和尿β2微球蛋白、尿NAG酶以及造影剂肾病发生率等指标。结果无论对照组还是治疗组,应用造影剂对患者肾功能均有明显影响(P<0.05)。应用造影剂后24 h治疗组血胱抑素C、尿β2微球蛋白和尿NAG酶数值明显低于对照组:血胱抑素C[(1.32±0.40)vs(1.50±0.58),P<0.05];尿β2微球蛋白[(206±89.4)vs(237.5±88)μg/L,P<0.05];尿NAG酶[(16.8±5.5)vs(20.1±6.1)U/L,P<0.05];其余指标无明显差异。应用造影剂后48 h治疗组肾小球和肾小管功能指标均显著优于对照组:血胱抑素C[(1.11±0.45)vs(1.34±0.46),P<0.05];尿素氮[(8.2±3.2)vs(9.2±3.7)mmol/L,P<0.05];肌肝(102.6±27.7)vs(112.4±40.8)μmol/L,P<0.05;肌酐清除率(82.1±25.5)vs(71.3±44.5)μmol/L,P<0.05;尿β2微球蛋白[(234.9±108.0)vs(266.2±105.7)mmol/L,P<0.05];尿NAG酶[(20.5±4.1)vs(22.7±5.0)U/L,P<0.05]。应用造影剂后5d治疗组和对照组比较,除血胱抑素C外,其他指标仍有显著差异:尿素氮[(7.2±2.8)vs(8.1±3.0)mmol/L,P<0.05];肌肝[(86.4±26.8)vs(96.3±35.7)μmol/L,P<0.05];肌酐清除率[(94.7±31.9)vs(86.2±21.0)ml/min,P<0.05];尿β2微球蛋白[(199.1±80.9)vs(232.5±92.1)μg/L,P<0.05];尿NAG酶[(16.6±5.0)vs(20.6±6.7)U/L,P<0.05]。治疗组造影剂肾病发生率明显低于对照组:5/95 vs 10/94,P<0.05。结论苯磺酸氨氯地平对老年冠心病患者造影剂相关肾损害具有一定的预防保护作用。Objective To evaluate the protective effect of amlodipine against contrast agent-induced renal injury in elderly patients with coronary heart disease. Methods A total of 189 elderly patients （〉60 years） with coronary heart disease undergoing coronary artery angiography were randomly assigned into amlodipine group and control group to receive amlodipine or placebo, respectively, before and after admirdstration of the contrast agent. At 24 h, 48 h and 5 days after contrast agent administration, the parameters of renal function were measured including serum cystin C, urea nitrogen, creatinine, creatinine clearance rate, urine β2-microglobulin, and urine N-acetyl-β-glucosaminidase. Results In both groups, the contrast agents obviously affected the renal functions of the patients （P〈0.05）. At 24 h after contrast administration, the levels of serum cystatin C, urine ~2-microglobulin and urine NAG were significantly lower in amlodipine group than in the control group, but the other functional parameters showed no significant difference. At 48 h after contrast administration, the glomerular and tubular functional parameters were all superior in amlodipine group （P〈0.05）. At 5 days, the two groups showed significant differences in such glomerular and tubular functional parameters as urea nitrogen, creatinine, creatinine clearance rate, urine β2-microglobulin, and urine NAG （P〈0.05）, but not in serum cystatin C level. The incidence of contrast agent-induced nephropathy was significantly lower in amlodipine group than in the control group （5/95 vs 10/94, P〈0.05）. Conclusions Amlodipine offers protection against radiographic contrast agent-induced renal injury in elderly patients with coronary heart disease.

关 键 词：老年 冠心病 苯磺酸氨氯地平 造影剂相关肾损害 

分 类 号：R544.1[医药卫生—心血管疾病]