摘要
目的观察肾素血管紧张素系统(RAS)阻断剂(RASI)对冠状动脉介入术后对比剂急性肾损害(CI-AKI)的影响。方法根据介入术前RASI应用情况将401例患者分为3组:血管紧张素转换酶抑制剂(ACEI)组(n=204);血管紧张素受体拮抗剂(ARB)组(n=63);非RASI组(n=134)。同时根据估算的肾小球滤过率(eGFR),再将各组分为肾功能正常组[eGFR>90mL/(min·1.73m^2)]和轻度肾功能不全组[eGFR 60~90mL/(min·1.73m^2)]两个亚组。所有患者围手术期均给予常规水化,测定冠状动脉介入术前及术后24、72h肾功能变化,观察CI-AKI的发生情况。结果与非RASI组相比,应用对比剂后72h,ARB组(14.3%比5.2%,P<0.05)和ACEI组(11.3%比5.2%,P<0.05)CI-AKI的发生率均升高。ACEI组介入前与介入后血肌酐、eGFR和血尿素氮水平与非RASI组差异无统计学意义,ARB组血肌酐高于ACEI组和非RASI组[24h:(98.0±46.8)比(86.0±33.0)、(84.4±24.9)μmol/L;72h:(102.5±49.2)比(91.1±38.9)、(87.2±26.0)μmol/L;均P<0.05],eGFR低于ACEI组和非RASI组[24h:(74.3±23.0)比(84.4±29.0)、(84.2±24.7)mL/(min·1.73m^2);72h:(70.6±21.9)比(80.1±27.7)、(81.4±25.3)mL/(min·1.73m^2);均P<0.05]。在肾功能正常人群,ARB组CI-AKI发生率显著高于非RASI组(17.1%比4.5%,P<0.05);在轻度肾功能不全人群,ACEI组CI-AKI发生率较非RASI组升高(13.4%比6.7%,P<0.05)。结论冠状动脉介入术前ARB治疗显著增加肾功能正常者CI-AKI发生,而对肾功能受损患者,ACEI显著增加CI-AKI发生。
Objective To investigate the effects of renin angiotensin system （RAS） inhibitors（RASI） on contrast-induced acute kidney injury （CI-AKI） after percutaneous coronary intervention （PCI）. Methods A total of 401 patients were divided into three groups according to RASI used before PCI： angiotensin-converting enzyme inhibitors （ACEI） group （n=204）, angiotensin receptor blockers （ARB） group （ n = 63 ） and non-RASI group （n = 134 ）. Then these participants were subdivided into normal renal function group[eGFR〉90 mL/（ min · 1.73 m2 ）] and mild renal dysfunction group[eGFR 60-90 mL/{ min·1.73 m2 ）]. Conventional hydration was conducted in all subjects before and after PCI. The changes of renal function before and 24 h and 72 h after coronary intervention were monitored, and the occurrence of CI-AKI was observed. Results The incidence rate of CI-AKI was higher in ACEI and ARB groups than that in non-RASI group （14.3 %, 11.3% vs 5.2 %, both P〈0.05）. The differences of serum creatinine, eGFR and blood urea nitrogen level before and after PCI were not statistically significant in ACEI and non-RASI group. Serum creatinine level was higher [24 h： （98.0±46.8） vs （86.0±33.0）, （84.4±24. 9）μmol/L; 72 h： （102.5±49.21 vs （91.1±38, 9）, （87.2±26.0）μmol/L;both P〈0.05],and eGFR level was lower [24 h： （74.3±523.0） vs （84.4±29.0）, （84.2±24.7）mL/（min. 1.73 m2）; 72 h： （70.6±21.9） vs （80.1±27.7）, （81.4±25.3）mL/（min ·1.73 m2 ） ;both P 〈0.05] in ARB group than those in ACEI and non-RASI group. In patients with normal renal function, the incidence rate of CI-AKI was higher in ARB group than non-RASI group （17. 1% vs 4. 5%, P〈0.05） ; While in patients with renal dysfunction, the incidence rate of CI-AKI was higher in ACEI group than non-RASI group （13.4% vs 6.7%, P〈0.05）. Conclusion Treatment with ARBs before PCI increased the incidence rate of CI-AKI in patients with normal renal function, while for t
作者
余福玲
汪义云
谢泓
柴大军
苏津自
林金秀
彭峰
蔡洪斌
YU Fu-ling;WANG Yi-yun;XIE Hong;CHAI Da-jun;SU Jin-zi;LIN Jin-xiu;PENG Feng;Cai Hong-bin(Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian 350005, Chin)
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2017年第12期1163-1168,共6页
Chinese Journal of Hypertension
