急诊经皮冠状动脉介入治疗术前强化阿托伐他汀治疗预防对比剂肾病的疗效  

Effects and its mechanisms of high-dose atorvastatin on contrast induced nephropathy after emergency percutaneous coronary intervention

作　　者：郭晓华[1] 李俊萍[1] 张昕[1] 张格日乐 

机构地区：[1]包头医学院第一附属医院心内科,内蒙古包头014010

出　　处：《中国介入心脏病学杂志》2015年第5期273-276,共4页Chinese Journal of Interventional Cardiology

基　　金：内蒙古自治区自然科学基金(2011MS1130)

摘　　要：目的研究阿托伐他汀对急诊经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)的保护作用及其作用机制。方法入选158例急性ST段抬高心肌梗死行急诊PCI术的患者,随机分为强化剂量组(80例,术前给予阿托伐他汀80 mg)和常规剂量组(78例,术前给予阿托伐他汀20 mg),比较不同剂量阿托伐他汀治疗后患者血肌酸酐、尿素氮、肌酐清除率、CIN发生率、尿微量白蛋白、α1-微球蛋白、超氧化物歧化酶、丙二醛、C反应蛋白的变化。结果强化剂量组比常规剂量组术后血肌酸酐下降,肌酐清除率升高,血浆超氧化物歧化酶水平升高,而丙二醛、C反应蛋白、尿α1-微球蛋白水平降低(均P<0.05);尿微量白蛋白有下降趋势,但差异无统计学意义(P>0.05);强化剂量组对比剂肾病发生率低于常规剂量组(P<0.05)。结论急诊PCI术前强化阿托伐他汀治疗可降低对比剂肾病的发生率,其疗效与他汀剂量相关;阿托伐他汀可能通过抗炎、抗氧化应激作用来保护肾功能,减少对比剂肾病的发生。Objective To study the protective effects and its mechanisms of high-dose atorvastatin on contrast induced nephropathy （CIN） after emergency percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI） . Methods 158 patients undergoing emergency PCI for STEMI were randomly divided into high-dose group （ n = 80 patients, with 80 mg of atorvastatin） and regular-dose group （n = 78 patients, with 20 nag of atorvastatin） according to the dosage of atorvastatin given before PCI. Scr, BUN, microalbuminuria, α1-micrglobulin （α1-MG）, superoxide dismutase （SOD） , malonaldehyde （MDA） , CRP were tested in all patients before and the first day after PCI. The rates of CIN were also compared between the 2 groups. Results There were lower level of Scr, MDA, CRP and α1-MG in the high-dose group than in the regular dose group, and higher level of Ccr, SOD in the high-dose group than in the regular dose group （ all P 〈 0. 05 ） . Microalbuminuria had a downward trend, but there was no statistical significance （P 〉 0. 05 ） . The rates of CIN was lower in the high dose group than in the regular dose group （2.5% vs. 10.3%, P= 0.043） . Conclusions Administration of high dose atorvastatin before PCI may decrease the occurrence of CIN after emergency PCI for STEMI. Atorvastatin shows effects in anti-inflammation, anti-oxidation and reduces the toxicity of the glomerular injury by contrast.

关 键 词：经皮冠状动脉介入治疗 阿托伐他汀 对比剂肾病 

分 类 号：R541.4[医药卫生—心血管疾病]