普罗布考预防急诊冠状动脉介入术后对比剂急性肾损害及光抑素C早期诊断价值的随机化临床研究  

Effect of probucol and the predictive value of cystain C on contrast-induced acute kidney injury after primary angioplasty:a prospective,randomized trial

作　　者：尹力[1] 李广平[1] 刘彤[1] 袁如玉[1] 郑心田[1] 许纲[1] 刘恩照[1] 徐延敏[1] 车京津[1] 刘相丽[1] 李飞雪[1] 马向红[1] 陈欣[1] 吴雷[1] 樊振旺[1] 阮艳[1] 何梅[1] 李一丁[1] 

机构地区：[1]天津医科大学第二医院心脏科,300211

出　　处：《中国介入心脏病学杂志》2012年第5期267-270,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨血清半胱氨酸蛋白酶抑制剂C(CyC)在早期诊断对比剂急性肾损害(CIAKI)方面的价值及普罗布考预防急诊PCI术后对比剂急性肾损害的作用。方法本项前瞻性、随机化临床试验共纳入204例因急性冠状动脉综合征接受急诊PCI术的患者(其中普罗布考组96例,对照组108例)。在术前及术后1、2、3天分别取血测定CyC及血清肌酐(Scr)水平。结果以术后CyC增高大于或等于10%作为早期诊断CIAKI的切线值,其敏感性为96.3%,特异性为67.23%;阴性预测值为100%,阳性预测值为30.32%。以Scr为测定值的CIAKI的发生率是13.24%,其中普罗布考组4.17%,对照组21.30%(χ2=11.53,P<0.001)。以CyC为测定值的CIAKI的发生率是41.18%,其中普罗布考组29.16%,对照组51.85%(χ2=10.79,P<0.001)。结论 CyC是早期排除CIAKI的可靠指标。在急诊PCI治疗术的患者,围手术期预防性使用普罗布考能降低CIAKI发生的风险。Objective Several studies have reported the role of probucol on the prevention of Contrast-induced acute kidney injury （CIAKI）. To date, the effect of probucol on cystatin C （CyC）-based CIAKI has not been described. This study was designed to examine the incidence of CyC-based CIAKI and investigate the effect of probueol on the prevention of CIAKI after primary coronary angioplasty. Methods We conducted a prospective, randomized trial on 204 patients （96 patients in the probucol group and 108 patients in the control group） who underwent primary angioplasty. Serum CyC and serum creatinine （Scr） concentrations were measured before, and on dayl, day2 and day3 after primary intervention. Results The CyC increase I〉 10% after exposure to contrast medium was the best increment cutoff value for the early identification of patients at risk for CIAKI with sensitivity of 96. 30% and specificity of 67.23%. The negative predictive value was 100% and the positive predictive value was 30. 32%. The overall incidence of Scr-based CIAKI was 13.24% （4. 17% in the probueol group and 21.30% in the control group; P 〈0. 001 ）. The overall incidence of CyC-based CIAKI was 41.18% （29. 16% in the probucol group and 51.85% in the control group; P 〈 0. 001 ）. Conclusions This study suggests that CyC is a reliable marker for early identification and ruling out the patients at the risk of CIAKI. Among the patients with ACS who are undergoing primary angioplasty, prophylactic treatment with probucol periprocedural stage decrease the risk of Scr and CyC-based CIAKI.

关 键 词：造影剂 肾功能不全 急性冠状动脉综合征 普罗布考 血清半胱氨酸蛋白酶抑制剂C 血清肌酐 

分 类 号：R587.104[医药卫生—内分泌]