左卡尼汀对冠心病合并糖尿病患者介入治疗术后发生对比剂肾病的临床疗效观察  

Effect of L-carnitine on Preventing Contrast-induced Nephropathy in Patients With Coronary Artery Disease Combining Diabetes Mellitus After Percutaneous Coronary Intervention

作　　者：何海燕[1] 李文华[1] 王琳[1] 余亚仁 陈静[1] 

机构地区：[1]徐州医学院附属医院心内科,江苏省徐州市221002

出　　处：《中国循环杂志》2015年第4期322-325,共4页Chinese Circulation Journal

摘　　要：目的:探讨在常规水化治疗的基础上加用左卡尼汀(L-carnitine)能否更有效地减少冠心病合并糖尿病高危患者经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)的发生率,并观察其临床疗效。方法:连续入选145例冠心病合并糖尿病的患者,随机分为两组。对照组(73例):仅用0.9%氯化钠溶液进行常规水化;治疗组(72例):在上述对照组的基础上,于术前三天及术后连续三天予以左卡尼汀注射液3.0 g静脉输注。所有入选患者分别于术前、术后24 h及48 h测定血清肌酐。留取尿液标本检测尿肾损伤分子1(KIM-1)。根据肾脏病饮食调整研究公式计算估测肾小球滤过率(eGFR)。比较两组患者对比剂肾病的发生率,观察术后患者的血肌酐(Scr)、尿KIM-1浓度变化及心血管不良事件发生情况。结果:145例患者中19例(13.1%泼生对比剂肾病,其中对照组14例(19.2%)发生对比剂肾病,治疗组5例(6.9%)发生对比剂肾病,治疗组与对照组比较,对比剂肾病的发生率差异有统计学意义(P<0.05)。两组患者血肌酐、估算的肾小球滤过率及尿肾损伤分子1变化显示,与对照组比较,治疗组术后24 h、48 h血肌酐降低、估算的肾小球滤过率升高及尿肾损伤分子1降低,差异均有统计学意义(P均<0.05)。所有患者均未出现严重的心血管不良事件。结论:对于冠心病合并糖尿病的患者短期应用左卡尼汀注射液可降低对比剂肾病的发生率。Objective：To investigate the efifcacy of L-carnitine （LC） based on routine hydration for preventing contrast-induced nephropathy （CIN） in patients with coronary artery disease （CAD） combining diabetes mellitus （DM） after percutaneous coronary intervention （PCI） in clinical practice. Methods： A total of 145 consecutive CAD patients with DM were enrolled, the patients were randomly divided into 2 groups： Control group, the patients received normal saline for routine hydration, n=73 and Intervention group, based on routine hydration, the patients received intravenous injection of LC 3.0 g/day at 3 days before and 3 days after the operation respectively, n=72. The serum creatinine （Scr） and urine kidney injury molecule 1 （KIM-1） were examined at before and 24 h, 48 h after the operation; according to the modiifcation of diet formula in renal disease patients, the glomerular iflter rates （eGF） were estimated. Results：There were 19/145 （13.1%） patients suffered from CIN, Control group had 14/73 （19.2%） and Intervention group had 5/72 （6.9%）, the CIN occurrence rate in Control group was higher than that in Intervention group, P〈0.05. Compared with Control group, the patients in Intervention group showed decreased Scr, KIM 1 and increased eGFR at 24 h and 48 h after the operation, all P〈0.05. There were no severe adverse cardiovascular events found in relevant patient. Conclusion： A short-term application of LC injection may reduce the CIN incidence in CAD patient with DM.

关 键 词：左卡尼汀 对比剂肾病 经皮冠状动脉介入治疗 

分 类 号：R541[医药卫生—心血管疾病]