瑞舒伐他汀对2型糖尿病合并肾功能不全及血压控制不良者冠脉介入治疗对比剂致急性肾损害的预防作用  

Preventive Efficacy of Rosuvastatin for Contrast-induced Acute Kidney Injury in T2DM Combined with Kidney Insufficiency Patients with Blood Pressure of Unsatisfactory Control during Percutaneous Coronary Intervention

作　　者：郑凌飞[1] 韩雅玲[1] 杨永健[2] 葛智平[3] 李淑梅[4] 金元哲[5] 徐凯[1] 李晶[1] 

机构地区：[1]沈阳军区总医院心血管内科,沈阳110016 [2]成都军区总医院心血管内科,成都610083 [3]内蒙古包钢医院心血管内科,内蒙古自治区包头014000 [4]吉林大学第二医院心血管内科,长春130011 [5]中国医科大学第四附属医院心血管内科,沈阳110032

出　　处：《解放军医药杂志》2016年第1期85-89,共5页Medical & Pharmaceutical 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：目的探讨冠状动脉介入治疗(PCI)围术期应用瑞舒伐他汀对2型糖尿病(T2DM)合并轻、中度肾功能不全、术前血压控制不理想患者对比剂所致急性肾损害(CIAKI)的预防作用。方法选择2008年12月—2011年10月T2DM合并轻、中度肾功能不全、拟行PCI术前血压控制不理想的患者1359例,随机分为瑞舒伐他汀组674例和对照组685例。瑞舒伐他汀组于入选开始每晚顿服瑞舒伐他汀持续应用至术后3 d,对照组术前至术后72 h内不服用任何他汀类药物。两组均于术前及术后第48、72小时检测血清肌酐(SCr)水平,同时观察CIAKI的发生率,并随访观察术后30 d心功能恶化及全因死亡发生率。结果两组术前SCr水平比较差异无统计学意义(P>0.05),瑞舒伐他汀组SCr PCI后最大值与对照组比较差异无统计学意义(P>0.05),但升高绝对值低于对照组(P<0.05)。PCI后瑞舒伐他汀组CIAKI发生率低于对照组(P<0.05)。术后30 d,两组心功能恶化及全因死亡发生率比较差异无统计学意义(P>0.05)。结论 T2DM合并轻、中度肾功能不全、PCI术前血压控制不理想的患者围术期连续应用瑞舒伐他汀可显著降低CIAKI的发生率。Objective To evaluate the preventive efficacy of Rosuvastatain for contrast-induced acute kidney injury （CIAKI） in type 2 diabetes mellitus （T2DM） patients complicated with mild or middle kidney insufficiency and blood pressure of unsatisfactory control during percutaneous coronary intervention. Methods A total of 1359 T2DM patients combined with mild or middle kidney insufficiency and with blood pressure of unsatisfactory control during percutaneous coronary intervention during December 2008 and October 2011 were selected, and were randomly divided into Ro- suvastatain group（n = 674） and control group （n = 685）. The Rosuvastatain group was given Rosuvastatain every night （1 time/d） from the day entering the group to the 3^th after the surgery, while the control group was not given statins before and within 72 h after the surgery. The levels of serum creatinine （SCR） before and at the 48^th and 72^th h after the surgery and CIAKI incidence rate in the two groups were detected respectively. The incidence rates of worsening cardiac function and all-cause death on the 30^th d after the surgery were observed and followed up. Results There was no significant difference in SCR level before operation between the two groups （P 〉 0.05）. The postoperative maximum SCR level in Rosuvastatain group showed no significant difference with that in control group （ P 〉 0.05 ） , but the rising absolute value of SCR level in Rosuvastatain group was significantly lower than that in control group （P 〈 0. 05）. The incidence rate of postoperative CIAKI in Rosuvastatain group was significantly lower than that in control group （P 〈 0. 05）. There were no significant differences in incidence rates of worsening cardiac function and all-cause death on 30^th d after the surgery between the two groups （P 〉 0.05）. Conclusion The continuous Rosuvastatain therapy during peroperative period can significantly reduce the CIAKI incidence rate for T2DM patients combined with mild or middle kidney in

关 键 词：瑞舒伐他汀 高血压 糖尿病 2型 肾功能不全 慢性 急性肾损伤 

分 类 号：R54[医药卫生—心血管疾病] R692[医药卫生—内科学]