复方丹参滴丸对冠心病患者经皮冠状动脉介入术后对比剂肾病的预防效果及作用机制  

Preventive Effect and Mechanism of Compound Danshen Dripping Pills on Contrast-Induced Nephropathy in Patients with Coronary Heart Disease after Percutaneous Coronary Intervention

作　　者：英硕 陈嫱 刘晓罡[1] 杨世诚[1] 李晓羽[1] 唐继超 宫鑫成 付涵 赵智程 张鹏[1] YING Shuo;CHEN Qiang;LIU Xiaogang;YANG Shicheng;LI Xiaoyu;TANG Jichao;GONG Xincheng;FU Han;ZHAO Zhicheng;ZHANG Peng(Department of Cardiology,Tianjin Chest Hospital,Tianjin 300222,China;Department of Respiratory and Critical Care Medicine,Tianjin Chest Hospital,Tianjin 300222,China;Graduate School of Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]天津市胸科医院心内科,300222 [2]天津市胸科医院呼吸与危重症医学科,300222 [3]天津医科大学研究生院,天津市300070

出　　处：《实用心脑肺血管病杂志》2022年第8期96-101,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：天津市卫生健康委员会天津市中医药管理局中医中西医结合科研课题(2021205)。

摘　　要：目的探讨复方丹参滴丸对冠心病患者经皮冠状动脉介入术(PCI)后对比剂肾病(CIN)的预防效果及作用机制。方法选取2019—2021年于天津市胸科医院心内科接受PCI的冠心病患者641例为研究对象。根据治疗方法,将患者分为复方丹参滴丸联合水化组(n=320)和单纯水化组(n=321)。为减小偏倚,应用倾向性评分以1∶1的比例进行分组配对(卡钳值为0.01),最终共纳入398例患者,其中复方丹参滴丸联合水化组和单纯水化组各199例。复方丹参滴丸联合水化组采用复方丹参滴丸联合水化进行治疗,单纯水化组采用水化治疗。比较两组匹配前后基线资料,术前、术后48 h肾功能指标〔血清尿素氮、血清肌酐、估算肾小球滤过率(eGFR)、β微球蛋白〕、超敏C反应蛋白(hs-CRP),术后CIN发生率。结果匹配前,复方丹参滴丸联合水化组男性占比、贫血发生率高于单纯水化组,心肌梗死发生率低于单纯水化组(P<0.05)。匹配后,两组年龄、性别、BMI、糖尿病发生率、高血压发生率、心肌梗死发生率、心力衰竭发生率、贫血发生率、ACEI/ARB使用率、利尿剂使用率、TG升高者占比、LDL-C升高者占比、对比剂用量、水化量比较,差异无统计学意义(P>0.05)。复方丹参滴丸联合水化组术后血清尿素氮、血清肌酐、β微球蛋白、hs-CRP低于单纯水化组,eGFR高于单纯水化组(P<0.05)。单纯水化组术后48 h血清肌酐、β微球蛋白、hs-CRP高于术前,eGFR低于术前(P<0.05);复方丹参滴丸联合水化组术后48 h血清尿素氮、eGFR低于术前,血清肌酐、β微球蛋白、hs-CRP高于术前(P<0.05)。复方丹参滴丸联合水化组CIN发生率低于单纯水化组(P<0.05)。多因素Logistic回归分析结果显示,复方丹参滴丸联合水化〔OR=0.16,95%CI(0.05,0.53)〕、对比剂用量为150~299 ml〔OR=0.19,95%CI(0.07,0.52)〕是冠心病患者PCI后发生CIN的保护因素,BMI≥28.0 kg/m〔OR=53.32,95%CI(9.23,307.92)〕Objective To investigate the preventive effect and mechanism of compound Danshen dripping pills on contrast-induced nephropathy(CIN)in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods A total of 641 patients with coronary heart disease who received PCI in the Department of Cardiology,Tianjin Chest Hospital from 2019 to 2021 were selected as the research objects.According to the treatment method,the patients were divided into compound Danshen dripping pills combined with hydration group(n=320)and simple hydration group(n=321).In order to reduce bias,the propensity score was used for grouping and matching at a ratio of 1∶1(caliper value was 0.01),and a total of 398 patients were finally included,including 199 cases in the compound Danshen dropping pills combined with hydration group and 199 cases in the simple hydration group.The compound Danshen dripping pills combined with hydration group was treated with compound Danshen dripping pills combined with hydration,and the simple hydration group was treated with hydration therapy.Baseline data before and after matching,renal function indexes[serum urea nitrogen,serum creatinine,estimated glomerular filtration rate(eGFR),βmicroglobulin],hypersensitive C-reactive protein(hs-CRP)before PCI and at 48 h after PCI,and the incidence of postoperative CIN were compared between the two groups.Results Before matching,the proportion of males and the incidence of anemia in the compound Danshen dropping pills combined with hydration group were higher than those in the simple hydration group,and the incidence of myocardial infarction was lower than that in the simple hydration group(P<0.05).After matching,there were no statistically significant differences in age,gender,BMI,the incidences of diabetes,hypertension,myocardial infarction,heart failure and anemia,the utilization ratios of ACEI/ARB and diuretics,the proportions of elevated TG and LDL-C,the dosages of contrast agent,hydration between the two groups(P>0.05).The postoperative ser

关 键 词：冠心病 肾病 造影剂 对比剂肾病 复方丹参滴丸 水化 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病] R256.5[医药卫生—内科学]