尼可地尔对经皮冠状动脉介入术后患者肾功能及炎性反应的影响研究  

Effect of Nicorandil on Renal Function and Inflammatory Response in Patients after Percutaneous Coronary Intervention

作　　者：娄明[1] 王璐璐[1] 冯春光[1] 刘奕[1] 宗斌[1] 李小莉[1] 张苗苗[1] LOU Ming;WANG Lulu;FENG Chunguang;LIU Yi;ZONG Bin;LI Xiaoli;ZHANG Miaomiao(Department of Cardiology,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]江苏省徐州市中心医院心内科,221009

出　　处：《实用心脑肺血管病杂志》2021年第11期48-51,68,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：徐州市科技项目应用基础研究计划(KC18028)。

摘　　要：背景对比剂肾病(CIN)已经成为住院患者发生急性肾损伤的第三位原因。CIN发病机制尚未完全阐明,临床亦无有效的预防药物。近年来有研究发现尼可地尔可以减轻肾脏细胞的氧化应激和炎性反应,最终降低CIN的发病率,但研究结果尚存在争议。目的探讨尼可地尔对经皮冠状动脉介入术后患者肾功能及炎性反应的影响。方法选取2019年7月至2020年2月在徐州市中心医院住院的接受经皮冠状动脉介入术的不稳定型心绞痛或非ST段抬高型心肌梗死患者160例为研究对象。采用随机数字表法将患者分为尼可地尔组和对照组,各80例。对照组患者遵照指南进行常规治疗;尼可地尔组患者除接受常规治疗外,在术前2 d到术后3 d给予尼可地尔10 mg口服,3次/d。比较两组患者CIN发生率,术前、术后血肌酐(Scr)、胱抑素C(CysC)、超敏C反应蛋白(hs-CRP)、白介素6(IL-6)。结果两组患者CIN发生率比较,差异无统计学意义(P>0.05)。尼可地尔组患者术后Scr、CysC、hsCRP、IL-6低于对照组(P<0.05)。对照组、尼可地尔组患者术后Scr、CysC、hs-CRP、IL-6分别高于本组术前(P<0.05)。结论尼可地尔对于经皮冠状动脉介入术后患者肾功能具有一定保护作用,可减轻患者的炎性反应,但并未发现其可以降低CIN发生率。Background Contrast-induced nephropathy(CIN) has become the third cause of acute renal injury in hospitalized patients. The pathogenesis of CIN is not yet to be identified, and there are no drugs to effectively prevent and control this disease. In recent years, nicorandil has been found to reduce the oxidative stress and inflammatory response of renal cells, which could reduce the incidence of CIN. But the results are still controversial. Objective To investigate the effect of nicorandil on renal function and inflammatory response in patients after percutaneous coronary intervention. Methods A total of 160 patients with unstable angina or non-ST elevated myocardial infarction who were hospitalized and underwent percutaneous coronary intervention in Xuzhou Central Hospital from July 2019 to February 2020 were selected as the research objects. The patients were divided into nicorandil group and control group by random number table method, 80 cases in each group. Patients in the control group received routine treatment according to the guidelines. In addition to routine treatment, patients in nicorandil group were given nicorandil 10 mg orally, 3 times a day from 2 days before operation to 3 days after operation. The incidence of CIN, preoperative and postoperative serum creatinine(Scr), cystatin C(CysC), high-sensitivity C-reactive protein(hs-CRP), and interleukin 6(IL-6) were compared between the two groups. Results There was no significant difference in the incidence of CIN between the two groups(P > 0.05). The postoperative Scr, CysC, hs-CRP and IL-6 in the nicorandil group were lower than those in the control group(P < 0.05). Scr, CysC, hs-CRP and IL-6 in the control group and nicorandil group after operation were higher than those before operation, respectively(P < 0.05). Conclusion Nicorandil has a certain protective effect on the renal function of patients after percutaneous coronary intervention, and can reduce the inflammatory response of patients, but it has not been found to reduce the incidence of CIN.

关 键 词：心绞痛 不稳定型 非ST段抬高型心肌梗死 肾病 对比剂 经皮冠状动脉介入治疗 尼可地尔 肾功能 炎性反应 

分 类 号：R541.4[医药卫生—心血管疾病] R542.22[医药卫生—内科学]