口服尼可地尔对急性ST段抬高型心肌梗死患者直接PCI术后对比剂肾病的预防作用  

Preventive effect of oral nicorandil on contrast-induced nephropathy in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

作　　者：樊延明[1] 蔡俊娜 张博[1] 周彬[1] 齐正 魏庆民[1] Fan Yanming;Cai Junna;Zhang Bo;Zhou Bin;Qi Zheng;Wei Qingmin(Department of Cardiology,People's Hospital of Xingtai City,Hebei Province,Xingtai 054000,China)

机构地区：[1]河北省邢台市人民医院心脏内科

出　　处：《中国循证心血管医学杂志》2019年第11期1333-1336,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省卫生和计划生育委员会科研基金项目青年科技课题(20171463)

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)围手术期口服尼可地尔对术后对比剂肾病(CIN)发生率的影响。方法本研究连续入选2016年9月至2018年1月就诊于河北省邢台市人民医院心脏内科的STEMI患者260例,随机分为尼可地尔组132例和对照组128例。尼可地尔组的患者在确诊STEMI后给予10 mg尼可地尔口服,而后以一次10 mg、2/d的剂量连续服用3 d;对照组给于除尼可地尔以外的其他标准药物治疗。所有患者于入院后即刻、术后24 h、48 h、72 h及7 d时化验血清肌酐(SCr)及胱抑素-C(Cys-C)。研究终点为直接PCI后CIN的发生和术后7 d内SCr及Cys-C的变化。结果本研究共有41例(15.77%)患者在直接PCI后发生CIN。尼可地尔组CIN的发生率明显低于对照组(10.61%vs.21.09%,P=0.031)。两组患者的SCr和Cys-C在术后24、48及72 h均较基线水平明显升高,在术后7 d时均恢复至基线水平;尼可地尔组术后48 h和72 h的SCr和Cys-C均明显低于对照组(P均<0.05),在术后24 h和7 d时两组患者的SCr和Cys-C均无统计学差异(P均>0.05)。结论STEMI患者直接PCI围手术期口服尼可地尔能够明显减少术后CIN的发生率,为CIN的预防提供了新的药物选择。Objective To investigate the influence of oral nicorandil on the incidence rate of contrastinduced nephropathy(CIN)in patients with acute ST-segment elevation myocardial infarction(STEMI)undergone primary percutaneous coronary intervention(pPCI)during preprocedural period.Methods STEMI patients(n=260)undergone pPCI were chosen from Department of Cardiology in People’s Hospital of Xingtai City of Hebei Province from Sept.2016 to Jan.2018,and then divided randomly into nicorandil group(n=132)and control group(n=128).The nicorandil group was orally given nicorandil(10 mg)after definite STEMI diagnosis followed by nicorandil(10 mg once)and twice a day for 3 d continuously.The control group was given other drugs except of nicorandil.The levels of serum creatinine(SCr)and serum cystatin C(Cys C)were detected at time points of immediate time after admission and after pPCI for 24 h,48 h,72 h and 7 d in all groups.The study endpoint was CIN incidence after PCI and the changes of SCr and Cys-C within 7 d after pPCI.Results There were 41 patients(15.77%)with CIN after pPCI.The incidence rate of CIN was significantly lower in nicorandil group than that in control group(10.61% vs.21.09%,P=0.031).The levels of SCr and Cys-C increased significantly compared with baseline in 2 groups after 24 h,48 h and 72 h,and recovered to baseline level after 7 d.The levels of SCr and Cys-C were significantly lower in nicorandil group than those in control group after 48 h and 72 h(all P<0.05).The levels of SCr and Cys-C had no statistical difference between 2 groups after 24 h and 7 d(all P>0.05).Conclusion Nicorandil taken orally in perioperative period of pPCI can significantly reduce the postoperative incidence rate of CIN in STEMI patients,which provide a new drug choice for preventing CIN.

关 键 词：尼可地尔 急性ST段抬高型心肌梗死 对比剂肾病 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]