中药制剂丹参多酚酸盐对急诊经皮冠状动脉介入治疗术后对比剂肾病的保护作用  

Protective effects of salvianolate on contrast-induced nephropathy after primary percutaneous coronary intervention

作　　者：黄晶[1] 袁敏杰[1] 马士新[1] 杭靖宇[1] 魏钧伯[1] 赵钢[1] 李京波[1] 魏盟[1] 陆志刚[1] 

机构地区：[1]上海交通大学附属第六人民医院心内科,上海200233

出　　处：《中国介入心脏病学杂志》2017年第1期35-41,共7页Chinese Journal of Interventional Cardiology

基　　金：上海市卫生和计划生育委员会中医药科研基金项目(2014LP027A)

摘　　要：目的评价丹参多酚酸盐对急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后对比剂肾病(contrast-induced nephropathy,CIN)的保护作用,分析急诊PCI术后发生CIN的危险因素。方法连续入选2014年12月至2016年7月上海交通大学附属第六人民医院因急性心肌梗死接受急诊PCI术的患者,随机分入丹参多酚组和单纯水化组,比较两组患者术后CIN的发生率以及血肌酸酐(serum creatinine,Scr)、估算的肾小球滤过率(estimated glomerular filtration rate,e GFR)和胱抑素C的变化情况,并比较两组不良事件的发生情况。通过多因素logistic回归,分析急诊PCI术后发生CIN[以Scr水平绝对升高≥0.5 mg/dl(44.2μmol/L)为诊断标准]的危险因素。结果共入选314例患者,最终306例(丹参多酚组152例,单纯水化组154例)纳入统计。丹参多酚组与单纯水化组相比,急诊PCI术后CIN的发生率(13.2%比26.6%,P=0.003)和CIN的发生风险(OR 0.340,95%CI 0.170~0.678,P=0.002)降低,术后Scr绝对升高值[(28.99±22.59)μmol/L比(36.79±35.26)μmol/L,P=0.022]和相对升高幅度[(39.15±29.07)%比(51.00±41.84)%,P=0.009]较低,术后e GFR绝对降低值[(29.03±20.11)ml/(min·1.73 m2)比(34.29±19.82)ml/(min·1.73 m2),P=0.004]和相对降低幅度[(28.46±15.11)%比(33.22±17.08)%,P=0.010]较小。丹参多酚组术后1个月内的联合不良终点事件发生率低于单纯水化组(13.8%比26.6%,P=0.005)。多因素logistic回归分析显示,较高肌酸激酶(creatine kinase,CK)峰值水平(OR 1.245,95%CI1.064~1.457,P=0.006)和氨基末端B型脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-pro BNP)峰值水平(OR 1.158,95%CI 1.011~1.327,P=0.034)是发生CIN的独立危险因素。结论丹参多酚酸盐对急诊PCI术后CIN的发生有一定的保护作用,并可降低近期不良事件的发生率。较高的CK和NT-pro BNP峰值水平是急诊PCI术后发生CIN的独立危险因素。Objective To estimate whether salvianolate has protective effects on contrast-induced nephropathy （CIN） and investigate the predictors of CIN after primary percutaneous coronary intervention （PCI）. Methods We prospectively and consecutively recruited patients who were diagnosed with acute myocardial infarction and underwent primary PCI in our hospital from December, 2014 to July, 2016. Patients were randomly assigned in a 1：1 ratio into the salvianolate group and the normal saline hydration group. The incidence of CIN and change in serum creatinine （Scr） , estimated glomerular filtration rate （eGFR） and cystatin C （Cys C） after procedure were compared between the two groups. The incidence of adverse events between the two groups was also observed. Multivariate logistic regression analysis was performed to determine the independent correlation of CIN after primary PCI. Results A total of 314 patients were recruited, of whom 306 patients were included eventually for statistics （152 in salvianolate group and 154 in control group ） analysis. As compared with the control group, salvianolate reduced the incidence of CIN （ 13.2% vs. 26.6% , P = 0. 003 ） and risk of CIN （ OR 0. 34, 95% CI 0. 170-0. 678,P = 0. 002） after primary PCI. Increase in Set after PCI was in a more minor degre in the salvianolate group compared to the control in absolute elevation [ （ 28.99 ± 22. 59 ） μmol/L vs. （ 36. 79± 35.26 ）μmol/L, P=0.022] and in relative elevation [（39.15 ±29.07）% vs. （51.00±41.84）%, P=0.009]. The decrease in eGFR was minor in the salvianolate group as well[ （ 29. 03 ± 20. 11 ） ml/（ min· 1.73 m^2 ） vs. （34.29±19.82） ml/（min·1.73 m^2）, P=0.004; （28.46±15.11）% vs. （3.22±17.08）%,P= 0. 010]. The composite endpoint adverse events rate was lower in the salvianolate group within 1 month after procedure （ 13.8% vs. 26. 6%, P = 0. 005 ）. Multivariate logistic regression analysis demonstrated that higher peak value of creatine kinase （CK） �

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 对比剂肾病 丹参多酚酸盐 

分 类 号：R541.4[医药卫生—心血管疾病] R692.9[医药卫生—内科学]