摘要
目的探讨大剂量阿托伐他汀序贯治疗对急性非ST段抬高型心肌梗死行择期经皮冠状动脉介入治疗（PCI）患者对比剂肾病（CIN）的影响。方法将100例急性非ST段抬高型心肌梗死并择期行PCI患者随机分为大剂量阿托伐他汀序贯治疗组（简称序贯治疗组）和对照组。所有患者入院即刻给予80 mg阿托伐他汀钙,随后40 mg/d,术前均给予水化治疗。序贯治疗组术前6 h内追加40 mg阿托伐他汀钙,对照组术前未追加阿托伐他汀钙。所有患者分别于PCI术前、术后24 h、48 h测定并比较血清肌酐（Scr）、内生肌酐清除率（Ccr）和CIN发生率。结果两组患者术前、术后24 h、48 h Scr和Ccr相比差异均无统计学意义;与术前相比,序贯治疗组术后24 h、48 h Scr和Ccr均无明显变化,对照组术后24 h Scr和Ccr无明显变化,术后48 h Scr明显上升,Ccr明显下降（P〈0.05）。与术后24 h比较,两组术后48 h Scr明显上升,Ccr明显下降（P=0.00）。所有CIN患者术后7～10天Scr均降至正常范围内;两组患者CIN发生率相比差异无统计学意义（16%比15%,P=0.585）。结论对于术前已使用阿托伐他汀钙40 mg/d调脂方案患者,围手术期再次予阿托伐他汀钙40 mg治疗并不能降低CIN发生率。
Aim To study the beneficial effects of high dose atorvastatin sequential treatment in preventing contrast-induced nephropathy（ CIN） in acute non-ST-segment elevation acute myocardial infarction（ NSTEMI） patients underwent elective percutaneous coronary intervention（ PCI）. Methods One hundred patients with NSTEMI undergone elective PCI were randomly divided into two groups： high dose atorvastatin sequential treatment group（ sequential treatment group for short） and control group. All patients were given 80 mg atorvastatin instantly and then 40 mg once a day. On the basis of hydration therapy,sequential treatment group received additional 40 mg atorvastatin at 6 hours before PCI.Serum creatinine（ Scr）,endogenous creatinine clearance rate（ Ccr） and the incidence rate of CIN were measured and compared 24 hours and 48 hours post-PCI. Results The levels of Scr,Ccr had no significant difference in the two groups at all time points. Compared with the preoperative,Scr and Ccr had no significant changes postoperatively in sequential treatment group. In control group,Scr and Ccr had no significant change 24 hours postoperatively,Scr had significantly increased,Ccr had significantly decreased after 48 hours（ P〈0.05）. Compared with 24 h postoperatively,Scr had significantly increased,Ccr had significantly decreased（ P = 0.00）. Scr decreased to the normal range after 7 ～ 10 days in all patients with CIN. The CIN incidence rate had no significant difference in the two groups（ 16% vs. 15%,P = 0.585）.Conclusion For patient who had used lipid-lowering program before PCI： 40 mg / d atorvatatin,the strategy of reload atorvastatin 40 mg can not reduce the CIN incidence rate.
出处
《中国动脉硬化杂志》
CAS
北大核心
2016年第7期711-714,共4页
Chinese Journal of Arteriosclerosis
关键词
阿托伐他汀
对比剂肾病
急性非ST段抬高型心肌梗死
经皮冠状动脉介入治疗
Atorvastatin
Contrast-induced Nephropathy
Acute Non-ST-segment Elevation Myocardial Infarc tion
Percutaneous Coronary Intervention
