阿托伐他汀对老年糖尿病患者行造影术后肾功能的影响  

Effect of atorvastatin on renal function in aged patients with diabetes mellitus after angiography

作　　者：全军民[1] 邱樑 陶袁[1] 吕锋[1] 姚琪[1] 

机构地区：[1]浙江嵊州市人民医院心内科,嵊州312400

出　　处：《新医学》2014年第8期542-546,共5页Journal of New Medicine

摘　　要：目的观察阿托伐他汀对老年糖尿病患者行造影术后肾功能的影响。方法 60例拟行造影术的老年糖尿病患者随机分为对照组、20 mg阿托伐他汀组和40 mg阿托伐他汀组各20例。20mg、40 mg阿托伐他汀组于造影术前3 d每晚分别顿服阿托伐他汀20 mg、40 mg,对照组未服用阿托伐他汀及其他调脂类药。观察患者造影前、造影后2、7 d血清肌酐(Scr)、胱抑素C(Cys C)、肌酐清除率(Ccr)、尿视黄醇结合蛋白(RBP)、超敏C反应蛋白(hs-CRP)的改变情况。结果 1造影后2 d,对照组Scr升高明显,Ccr下降,与术前比较有统计学意义(P<0.05),并出现1例造影剂肾病。2造影后2 d,3组血Cys C、hs-CRP、尿RBP均明显升高,对照组升高尤为明显,20 mg他汀组次之,40 mg他汀组升幅最小,3组比较差异均有统计学意义(P<0.05)。3与术后2 d相比,术后7 d,3组Cys C、hs-CRP、尿RBP均下降,40 mg他汀组最接近基线水平,20 mg他汀组次之,3组比较差异均有统计学意义(P<0.05)。结论老年糖尿病患者造影前3 d应用阿托伐他汀能改善造影剂引起的肾功能损害,可能具有剂量依赖性,其机制可能与阿托伐他汀抗炎和改善血管内皮功能有关。血清Cys C、尿RBP可作为造影剂肾病早期肾损伤的灵敏检测指标。Objective To observe the influence of atorvastatin on renal impairment in aged patients with diabetes mellitus （DM） caused by contrast agents after angiography. Methods A total of 60 elderly DM patients requiring angiography were prospectively enrolled and randomly assigned to the atorvastatin groups （20 mg/qn, n = 20; 40 mg/qn, n = 20） and control group （n = 20）. Patients in the atorvastatin groups received atorvastatin for three days before angiography and those in the control group had no atorvastatin or other statins. The levels of high sensitivity C-reactive protein （hs-CRP）, cystain C （Cys C） , serum creatinine （Scr） and urinary retinal binding protein （RBP） were detected and creatinine clearance rate （Ccr） was calculated before and on the 2nd and 7th days after angiography, respectively. Results ① In the control group, serum level of creatinine was increased whereas Ccr was decreased on the 2nd day after angiography compared the levels before angiography （ both P 〈 0. 05 ）. One patient presented with contrast agent-induced nephropathy. ② Among all three groups, serum levels of Cys C, hs-CRP and urinary RBP were significantly elevated on the 2nd day after angiography （ all P 〈 0. 05 ）. The largest increase was noted in the control group followed by 20 mg- and 40 mg-atorvastatin groups. ③ The levels of serum Cys C, hs-CRP and urinary RBP in all three groups were decreased on the 7th day after angiography while the level in the 40 mg-atorvastatin group was similar to baseline level （ all P 〈 0. 05）. Conclusion Pretreatment with atorvastatin for three days for aged DM patients before angiography can effectively alleviate the renal impairment caused by contrast agents probably in a dose-dependent manner. This effect is possibly associated with the mechanisms of anti-inflammation and improving vascular endothelial function. Serum levels of Cys C and urinary RBP could serve as sensitive indexes for early renal damages caused by contrast agents.

关 键 词：阿托伐他汀 糖尿病 造影术 超敏C反应蛋白 尿视黄醇结合蛋白 

分 类 号：R587.1[医药卫生—内分泌]