强化阿托伐他汀对高剂量造影剂致对比剂肾病的临床研究

摘要/Abstract

摘要： 目的: 探讨和分析强化剂量阿托伐他汀对应用不同剂量非离子低渗造影剂碘帕醇患者肾功能的影响。方法: 将择期行冠状动脉造影(CAG)和经皮冠状动脉介入术(PCI)患者200例,随机分为强化剂量阿托伐他汀治疗组(100例)和常规剂量阿托伐他汀治疗组(100例),在全部采用水化治疗基础上,强化组给予强化剂量阿托伐他汀口服(术前 1 d 80 mg,术前 2 h 40 mg),常规组给予常规剂量阿托伐他汀口服(术前1 d 20 mg)。其中对进行单纯造影与造影后直接PCI术的患者根据造影剂用量的不同,分为≤120 mL 组和>120 mL 组,分别于术前、术后测定血清肌酐(Scr)、BUN及超敏C反应蛋白(hsCRP)等指标,按Cochcroft-Gault公式计算内生肌酐清除率(Ccr),并进行统计学分析。结果: 与术前相比,术后常规剂量组和强化剂量组患者Scr、BUN水平均明显升高,Ccr 均明显下降(P<0.05);常规剂量组患者hsCRP水平升高(P<0.05),而强化剂量组hsCRP水平变化相近(P>0.05)。强化剂量组的患者造影剂使用剂量的大小对肾功能无明显影响,≤120 mL 组和>120 mL 组比较差异无统计学意义(P>0.05),但常规剂量组肾功能差异具有统计学意义,表现为Scr、BUN及hsCRP水平≤120 mL 组较>120 mL 组升高(P<0.05),Ccr≤120 mL 组较>120 mL 组下降(P<0.05)。常规剂量阿托伐他汀治疗组发生对比剂肾病(CIN)患者有12例,发生率为12％;>120 mL 发生对比剂肾病患者有8例,发生率为14%。结论: 术前强化剂量阿托伐他汀治疗可显著降低高剂量造影剂对肾功能的影响,减少对比剂肾病的发生。

关键词: 阿托伐他汀, 对比剂肾病, 非离子低渗造影剂

Abstract: AIM: To investigate the effect of intensive dose atorvastatin in the use of iopamidol,a kind of low osmolar and non-ionic contrast agent,on renal function of patientsMETHODS: 200 patients who undergoing CAG and PCI were randomized to intensive dose atorvastatin group (80 mg 24 h before PCI,with a further 40 mg 2 h pre-procedure,n=100)or routine dose atorvastatin group (20 mg/d,n=100).All patients received intravenous saline hydration.And those who undergoing percutaneous PCI were divided into two groups according to different dosages of contrast agent :≤120 mL group and >120 mL group.The levels of Scr,BUN,and hsCRP were determined for the evidence of tubular or glomerular damage befour and after receiving diagnostic and therapeutic coronary intervention.Ccr was calculated according to Cockcroft-Gault formula.RESULTS: Compared with before operation,the values of Scr and BUN in two groups of patients were obviously higher after operation;but the value of Ccr was lower (P<0.05);the value of hsCRP was increased in routine dose atorvastatin group(P<0.05),the value of hsCRP was no change in intensive dose atorvastatin group(P>0.05).There was no significant difference in the values of renal function between ≤120 mL group and >120 mL group in intensive dose atorvastatin group.Compared with the >120 mL group,the values of the Scr,BUN,hsCRP were increased(P<0.05),the value of Ccr was decreased(P<0.05).The renal function had obvious diffenence in routine dose atorvastatin group between ≤120 mL group and >120 mL group. There were 12 patients with contrast-induced nephropathy (CIN)in routine dose atorvastatin group and the incidence of CIN was 12%;there were 8 patients with contrast-induced nephropathy (CIN)in>120 mL group,and the incidence of CIN was 14％.CONCLUSION: The use of intensive dose atorvastatin before angiography can reduce the effect of renal function induced by high dose of contrast agent and prevent the incidence of CIN.

Key words: Atorvastatin, Contrast-induced nephropathy, Non-ionic low permeability contrast agent

中图分类号:

陈笑瑛, 邹林林. 强化阿托伐他汀对高剂量造影剂致对比剂肾病的临床研究[J]. 中国临床药理学与治疗学, 2013, 18(6): 688-691.

CHEN Xiao-ying, ZOU Lin-lin. Clinical research of intensive dose atorvastatin on preventing contrast-induced nephropathy caused by high dose of contrast agent[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2013, 18(6): 688-691.

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