瑞舒伐他汀对糖尿病合并轻、中度肾功能不全老年患者介入诊治术后对比剂肾病的影响  

Effect of rosuvastatin on contrast-induced acute kidney injury after percutaneous coronary intervention in elder patients with diabetes associated with mild-moderate renal insufficiency

作　　者：刘昕明[1] 韩雅玲[1] 浦奎 孙玲 潘洪涛[4] 赵卫东 徐凯[1] 李晶[1] 

机构地区：[1]沈阳军区总医院心内科,沈阳110016 [2]254医院心内科,天津300140 [3]抚顺市中心医院心内科,辽宁抚顺113006 [4]吉林大学第四医院心内科,吉林省吉林市130011 [5]鞍山钢铁总医院心内科,辽宁鞍山114201

出　　处：《解放军医学杂志》2014年第4期265-270,共6页Medical Journal of Chinese People's Liberation Army

基　　金：国家科技重大专项课题(2012ZX09303016-002);辽宁省科技攻关项目(2013225089)~~

摘　　要：目的探讨瑞舒伐他汀对糖尿病合并轻、中度肾功能不全的老年患者经皮冠状动脉介入治疗（PCI）术后发生对比剂肾病（CIAKI）的影响。方法选取2008年12月-2011年10月53家医院的1204例曾接受冠脉介入治疗的老年（年龄≥65岁）糖尿病合并轻、中度肾功能不全患者，根据是否使用瑞舒伐他汀分为瑞舒伐他汀组（n=604）和对照组（n=600）。瑞舒伐他汀组患者于人选开始每晚顿服瑞舒伐他汀10mg，术前至少2剂，并持续应用至术后331]，合计5剂以上。对照组术前至术后72h内不服用任何他汀类药物。72h后，两组均可使用他汀类药物且种类不限。所有人选患者均于术前及术后48h及72h检测血清肌酐（Scr）水平，观察患者手术前后Scr水平的变化及CIAKI的发生率，并随访观察术后30d心功能恶化1级及全因死亡的发生率。结果两组患者术前Scr水平相似[95．46（46．00～415．00）μmol／L1／S96．45（47．00～254．40）μmol／L，P=0．131]，术后瑞舒伐他汀组患者Scr最大值明显低于对照组[95．42（45．00～405．00）μmol／Lps97．84（36．00～273．00）Ixmol／L，P=0．010]。瑞舒伐他汀组的CIAKI发生率（2．3％）明显低于对照组（5．2％，P=0．011）。术后30d随访发现两组患者心功能恶化1级及全因死亡的发生率差异无统计学意义（P〉o．05）。结论小剂量瑞舒伐他汀可显著降低老年糖尿病合并轻、中度肾功能不全患者的CIAKI的发生率，且疗效安全。Objective To evaluate the safety and efficacy of rosuvastatin in preventing of contrast-induced acute kidney injury （CIAKI） after percutaneons coronary intervention （PCI） in elder patients with diabetes associated with mild-moderate renal insufficiency （MMRI）. Methods From Dec. 2008 to Oct. 2011, 2998 patients from 53 centers in China were enrolled in a TRACK-D project. Of them, 1204 patients （≥ 65 years old） with type 2 diabetes mellitus （T2DM） and concomitant MMRI, who underwent PCI treatment, were randomly assigned to rosuvastatin group （n=604） and control group （n--600）. Patients in rosuvastatin group were given rosuvastatin 10mg/d for five days （two days before and three days post-procedure）, those in control group did not receive statins within 72 hours between pre- and post-operation. Serum creatinine concentration （Scr） was assessed before procedure and 48h and 72h after contrast media exposure. The changes of Scr before and after operation and the incidence of CIAKI, which was defined as an increase of Scr ≥ 0.5mg/dl （44.2μmol/L） or /〉 25% of baseline data, were observed. A 30-day clinical follow-up was performed including the incidence of cardiovascular events, drug adverse events and all-cause mortality. Results There was no significant difference in Scr between the two groups in baseline [95.46（46.00-415.00）μmol/ L vs 96.45（47.00-254.40）lxmol/L, P=0.131]. The postoperative Scr was significantly lower in rosuvastatin group than in control group [95.42（45.00-405.00）μmol/L vs 97.84（36.00-273.00）txmol/L, P=0.010]. The incidence of CIAKI was significantly lower in rosuvastatin group than in control group （2.3% vs 5.2%; P=0.011）. During a 30-day follow-up, the incidence of all-cause mortality and aggravation of heart dysfunction showed no significant difference between the two groups （P〉0.05）. Conclusion Small dose of rosuvastatin may reduce the risk of CIAKI significantly in elder patients with DM and MMRI undergoing arterial contra

关 键 词：瑞舒伐他汀 肾功能不全 慢性 糖尿病 老年人 造影剂 

分 类 号：R587.1[医药卫生—内分泌] R692[医药卫生—内科学]