依那普利叶酸片对老年冠心病合并肾功能轻度减低患者造影剂肾病发生的影响  

Effect of Enalapril-folic acid tablet on development of contrast-induced nephropathy after percutaneous coronary intervention in elderly patients with coronary heart diseases complicated with mild renal insufficiency

作　　者：鄢高亮[1] 周千星[1] 袁春菊[1] 潘啸东[1] 陈中璞[1] 侯建同 汤成春[1] 马根山[1] Yan Gaoliang;Zhou Qianxing;Yuan Chunju;Pan Xiaodong;Chen Zhongpu;Hou J iantong;Tang Chengchun;Ma Genshan(Department of Cardiology,Zhongda Hospital of Southeast University Medical School,Nanjing 210009,China Corresponding author：Tang Chengchun,Email：tangchengchun@m edmail,com.cn)

机构地区：[1]东南大学附属中大医院心内科,南京210009

出　　处：《中华老年医学杂志》2018年第9期966-970,共5页Chinese Journal of Geriatrics

基　　金：国家自然科学基金（81600227,81670237）

摘　　要：目的探讨依那普利叶酸片对老年冠心病合并肾功能轻度减低患者冠状动脉介入治疗（PCI）术后造影剂肾病（CIN）发生的影响。方法回顾性选取2013年1月至2016年6月至我院就诊并行择期PCI的老年（年龄≥60岁）冠心病患者935例，按围术期是否应用依那普利叶酸或其他血管紧张素转换酶抑制剂／血管紧张素受体拮抗剂类药物，将患者分为叶酸组296例，对照组639例。评估术后72h内血肌酐水平变化，分析两组患者间的基线资料和CIN发生率差异，采用多因素Logistic回归分析评价CIN的影响因素，观察术后1月内临床事件发生情况。结果叶酸组患者CIN发生率7．1％（B1／296）低于对照组11．1％（71／639），但差异无统计学意义（χ^2=3．679，P=0．059）。多因素Logistic回归分析结果显示，年龄（OR=1．103，P=0．001）、高血压（OR=3．362，P=0．017）和高Hcy血症（OR=3．528，P=0．003）是术后发生cIN的危险因素，而依那普利叶酸应用可能是CIN的保护因素（OR=0．443，P=0．042）。进一步的临床随访结果显示，叶酸组患者出院1个月心绞痛复发比例低于对照组（P〈0．05），而两组患者因肾功能恶化住院、透析或血滤、急性左心衰竭、新发心肌梗死事件发生率差异无统计学意义（均P〉0．05）。结论依那普利叶酸片可能对老年冠心病合并肾功能轻度减低的患者PCI术后发生cIN具有一定预防作用。Objective To explore the impact of Enalapril-folic acid tablet on development of contrast-lnduced nephropathy （CIN） after percutaneous coronary intervention （PCI） in elderly patients with coronary heart diseases（CHD） complicated with mild renal insufficiency. Methods A total of 935 old patients （≥60 years） undergoing selective PCI at our hospital from January 2013 to June 2016 were enrolled in this retrospective study. Based on treatments during the perioperative phase,the 935 patients were divided into Enalapril-folic acid tablet intervention group （n =296,31.7% ）, and other RAS blocker control group with Angiotensin eonverting-enzyme inhibitor （ACEI） or Angiotensin Ⅱ receptor blocker （ARB） （n=639,68.3%）. The levels of serum creatinine for 72 hours after operation were monitored and evaluated. Baseline data and CIN incidence were compared between two groups. The clinical events within 1 month after contrast media application were recorded. Multivariate Logistic regression analysis was used to analyze independent risk factors for CIN after PCI. Results The incidence of CIN after PCI was lower in the intervention group than in the control group with no statistical significance[7.1% （21/296） vs.11.1% （71/639）,χ^2=3.679,P=0.059]. Multivariate regression analysis showed that age （OR=1. 103,P =0. 001） ,hypertension （OR=3. 362,P=0. 017）, and hyper homoeysteinemia （OR =3. 528,P =0. 003） were independent risk factors, but the treatment with Enal.apri[-fo[ic acid tablet might he a protective factor （or development of CIN after PCI[ （OR=0. 443,P=0. 042）. During the l-month follow-up,the rate of recurrent angina pectoris was lower in the inlervention group than in the control group （P〈0.05）, while there were no statistically significant differences between two groups in the rates of rehospitalizadon due to worsening renal dysfunction, dialysis/hemofiltration, acute heart failure, and new myocardial infarction （all P 〉 O. 05 ）.

关 键 词：依那普利 叶酸 半胱氨酸 肾病 造影剂 

分 类 号：R541.4[医药卫生—心血管疾病]