摘要
目的研究短期大剂量阿托伐他汀治疗对经皮冠状动脉介入治疗(PCI)后患者肾功能的保护作用和预防对比剂急性肾损伤(CI-AKI)的效果,并探讨其可能机制。方法选择2015年7月至2016年10月心内科收治的176例择期PCI的急性冠脉综合征(ACS)患者,按随机数字表法分为强化他汀组(89例),常规他汀组(87例)。在联合水化治疗的基础上,强化他汀组PCI术前1d口服阿托伐他汀80mg,术后3d内口服40 mg/d,之后20mg/d;常规他汀组PCI术前1d及术后均口服阿托伐他汀20mg/d。于术后24、48 h分别测定血清肌酐水平并统计CI-AKI的发生率。分别使用单因素及多因素logistic回归分析可能影响CI-AKI发生的危险因素,以及短期大剂量他汀治疗与PCI术后CI-AKI的相关性。结果两组对象PCI术后24、48h血肌酐水平均升高,组间比较差异均无统计学意义(均P>0.05)。强化他汀组ΔCr 24～0h(术后24h较术前肌酐增加值)、ΔCr 48～0h、ΔCr 48～24h均比常规他汀组小,差异均有统计学意义(均P<0.05)。强化他汀组术后24h CI-AKI发生率为4.6%,常规他汀组为7.9%,两组比较差异无统计学意义(χ~2=0.80,P>0.05);强化他汀组术后48h CI-AKI发生率仍为4.6%,常规他汀术为13.5%,两组比较差异有统计学意义(χ~2=4.20,P<0.05)。单因素分析显示,短期大剂量他汀治疗与减少术后CI-AKI的发生密切相关(P=0.050);多因素分析结果显示,在矫正高龄、冠脉病变类型、高血压病、糖尿病、慢性肾脏病、心功能不全以及大剂量使用对比剂等混杂因素后,短期大剂量他汀治疗仍为术后CI-AKI的保护因素(P=0.010)。结论短期大剂量阿托伐他汀对PCI术后肾功能具有保护作用,可降低CI-AKI的发生率。
Objective To investigate the effects of short-term,high-intensity atorvastatin therapy in prevention of contrast-induced acute kidney injury(CI-AKI)after percutaneous coronary intervention(PCI).Methods One hundred and seventy six patients with acute coronary syndrome(ACS)undergoing PCI in Ningbo Second Hospital from July 2015 to October 2016 were randomly divided into intensive statin group(n=89)and conventional statin group(n=87).Patients in intensive statin group received 80mg/d atorvastatin 1d before PCI,40mg/d after PCI for 3 d and then 20 mg/d;patients in conventional statin group received atorvastatin 20 mg/d before and after PCI.The serum creatinine(Scr)levels were measured and the incidence of CI-AKI were observed at 24h or 48h after procedure.Univariate logistic regression and multivariable logistic regression analysis were used to analyze the risk factors of CI-AKI,and the correlation of intensive statin therapy and CI-AKI after PCI.Results The incidence of CI-AKI in intensive group and conventional group was 4.6%and 7.9%at 24h after procedure,respectively(χ^2=0.80,P=0.80);however,the incidence was lower in intensive group than that in conventional group at 48h after procedure(4.6%vs 13.5%.χ^2=4.20,P<0.05).The Scr levels were increased in both groups at 24h or 48h after procedure,there was no significant difference between two groups(P>0.05).The changes of Scr levelsΔCr24-0h,ΔCr48-0h,ΔCr48-24h were significantly lower in intensive statin group than those in conventional statin group(all P<0.05).Univariate logistic regression analysis showed that the intensive statin therapy was closely associated with the reduced incidence of postoperative CI-AKI(OR=0.309,95%CI:0.096-1.000).Multivariable logistic regression analysis showed that the intensive stain therapy was a protective factor for postoperative CI-AKI.Conclusion Short-term high-dose atorvastatin given during PCI in patients with ACS can protect renal function,reducee the occurrence of CI-AKI.
作者
孙加斌
叶红华
江隆福
沈根
SUN Jiabin;YE Honghua;JIANG Longfu(Department of Cardiology,Hua Mei Hospital,University of Chinese Academy of sciences,Ningbo 315000,China)
出处
《浙江医学》
CAS
2019年第4期340-344,共5页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划(2015KYA200)
