摘要
背景国内外研究表明介入手术围手术期服用一定剂量的阿托伐他汀或普罗布考可减轻对比剂急性肾损伤(CIAKI),但两者联用对CIAKI的影响尚未见报道。目的观察术前联用不同剂量的阿托伐他汀与普罗布考对高血压患者CIAKI的影响。方法连续筛选需住院接受择期冠状动脉造影(CAG)或经皮冠状动脉支架植入术(PCI)且合并高血压的冠状动脉粥样硬化性心脏病(冠心病)患者126例,随机分为3组,介入术前1～2d给予阿托伐他汀或普罗布考治疗:①标准联合剂量治疗组41例:阿托伐他汀20mg,每晚顿服;普罗布考250mg,3次/d;术前无强化。②强化联合剂量治疗组40例:阿托伐他汀40mg,每晚顿服;普罗布考250mg,3次/d;术前2h顿服阿托伐他汀40mg、普罗布考500mg。③强化剂量治疗组45例:阿托伐他汀40mg,每晚顿服,术前2h顿服阿托伐他汀40mg。所有患者均于术前,术后24h抽取静脉血,检测血尿素氮,血肌酐,肾素活性和血管紧张素Ⅱ(AngⅡ)、醛固酮水平,并采用MDRD方法估算肾小球滤过率(eGFR)。结果①与术前比较,标准剂量组及强化剂量组术后血肌酐升高,eGFR下降;强化联合剂量组术后尿素氮较术前下降,肌酐及eGFR变化无统计学意义。标准剂量组术后AngⅡ较术前升高,强化剂量组术后肾素活性升高,强化联合剂量组肾素各指标介入术前后的差异均无统计学意义。②强化联合剂量组血肌酐变化值(ΔScr)与标准剂量组和强化剂量组比较,差异均有统计学意义[(-2.6±14.6)比(7.4±21.4),(5.4±10.6)μmol/L,均P<0.05],eGFR变化值(ΔeGFR)与标准剂量组和强化剂量组比较,差异也均有统计学意义[(1.4±11.2)比(-4.5±10.6),(-4.3±10.4)mL/min,均P<0.05]。结论对于高血压患者,术前强化联合阿托伐他汀40mg和普罗布考250mg,3次/d,对CIAKI有改善作用。
Background Perioperative intervention therapy with atorvastatin or probucol could reduce contrast induced acute kidney injury（CIAKI）,but the effects of combination treatment of the two drugs on CIAKI in patients with hypertension remained unknown.Objective To evaluate the effects of different doses of atorvastatin combined with or without probucol on CIAKI in patients with hypertension experiencing coronary angiography（CAG）or percutaneous coronary intervention（PCI）.Methods One hundred twenty-six patients admitted for CAG or PCI were randomly divided into 3 groups.Low-dose combination treatment group（L-C group,n=41）：atorvastatin 20 mg/d and probucol 250 mg,3/d;high-dose combination treatment group（H-C group,n=40）：atorvastatin 40 mg/d and probucol 250 mg,3/d,with a further dose of atorvastatin 40 mg and probucol 500 mg 2 hours before intervention;high-dose atorvastatin treatment group（H-A group,n=45）：atorvastatin 40 mg/d,with a further dose of atorvastatin 40 mg 2 hours before procedure.In all 126 patients,blood samples were collected before and 24 h after angioplasty to measure serum creatinine（Scr）,blood urea nitrogen（BUN）,renin activity,angiotensin Ⅱ（Ang Ⅱ）and aldosterone level.Glomerular filtration rate（eGFR）were estimated using the modified diet in renal disease study（MDRD）formula.Results ① After angioplasty,Scr in L-C group and H-A group increased significantly,while eGFR of the two groups decreased markedly;In H-C group,BUN decreased significantly after treatment,Scr and eGFR showed no significant changes.②ΔScr in H-C group was significantly higher [（-2.6±14.6）vs（7.4±21.4）,（5.4±10.6）μmol/L,both P0.05] and ΔeGFR was markedly lower than that of the other two groups [（1.4±11.2）vs（-4.5±10.6）,（-4.3±10.4）mL/min,both P0.05].Conclusion For hypertensive patients,combination and intensive treatment of atorvastatin and probucol before angiography could attenuate the CIAKI.
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2010年第11期1044-1047,共4页
Chinese Journal of Hypertension
基金
天津卫生局攻关课题(10KG122)
