大剂量阿托伐他汀对老年急性心肌梗死患者造影剂肾病的预防和安全性研究
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摘要
目的观察大剂量阿托伐他汀对老年PCI造影剂肾病患者的预防和安全性。方法选取2017年1～12月南京市大厂医院心血管内科住院的老年急性心肌梗死行PCI患者90例,随机分为观察组45例和对照组45例。在PCI术前4d及术后3d,2组给予常规水化治疗、大量饮水、利尿等。在此基础上对照组口服阿托伐他汀10mg/晚,观察组40mg/晚。观察2组术前和术后血清肌酐、尿素和胱抑素C水平变化,记录2组治疗过程中造影剂肾病及不良反应发生情况。结果 2组术前血清肌酐、尿素和胱抑素C水平比较,差异无统计学意义(P>0.05)。2组术后血清肌酐、尿素和胱抑素C水平较术前明显升高,差异有统计学意义(P<0.05)。观察组术后血清肌酐、尿素和胱抑素C水平较对照组明显降低,差异有统计学意义(P<0.05)。观察组造影剂肾病发生率明显低于对照组,差异有统计学意义(8.9%vs 26.7%,P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论服用大剂量阿托伐他汀可明显改善老年心肌梗死患者PCI术后的肾功能,减少造影剂肾病的发生,是一种防治PCI造影剂肾病较好的方式。
引文
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[20]Chu S,Hu L,Wang X,et al.Xuezhikang ameliorates contrast media-induced nephropathy in rats via suppression of oxidative stress,inflammatory responses and apoptosis[J].Ren Fail,2016,38(10):1717-1725.DOI:10.1080/0886022X.2016.1207052.
[21]He X,Li L,Tan H,et al.Atorvastatin attenuates contrastinduced nephropathy by modulating inflammatory responses through the regulation of JNK/p38/Hsp27expression[J].JPharmacol Sci,2016,131(1):18-27.DOI:10.1016/j.jphs.2016.03.006.
[22]Watanabe M,Saito Y,Aonuma K,et al.Prediction of contrast-induced nephropathy by the serum creatinine level on the day following cardiac catheterization[J].J Cardiol,2016,68(5):412-418.DOI:10.1016/j.jjcc.2015.10.016.
[23]Benzer M,Alpay H,Baykan ?,et al.Serum NGAL,cystatin Cand urinary NAG measurements for early diagnosis of contrast-induced nephropathy in children[J].Ren Fail,2015,38(1):27-34.DOI:10.3109/0886022X.2015.1106846.
[24]Kim GS,Ko YG,Shin DH,et al.Elevated serum cystatin Clevel is an independent predictor of contrast-induced nephropathy and adverse outcomes in patients with peripheral artery disease undergoing endovascular therapy[J].J Vasc Surg,2015,61(5):1223-1230.DOI:10.1016/j.jvs.2014.11.079.
[25]Fu M,Dai W,Ye Y,et al.High dose of atorvastatin for the treatment of contrast-induced nephropathy after carotid artery stenting[J].Am J Ther,2017,24(6):e718-e722.DOI:10.1097/MJT.0000000000000407.
[2]Eng J,Wilson RF,Subramaniam RM,et al.Comparative effect of contrast media type on the incidence of contrast-induced nephropathy:a systematic review and meta-analysis[J].Ann Intern Med,2016,164(6):417-424.DOI:10.7326/M15-1402.
[3]Jain T,Shah S,Shah J,et al.Contrast-induced nephropathy in STEMI patients with and without chronic kidney disease[J].Crit Pathw Cardiol,2018,17(1):25-31.DOI:10.1097/HPC.0000000000000123.
[4]Ozcan OU,Adanir Er H,Gulec S,et al.Impact of metabolic syndrome on development of contrast-induced nephropathy after elective percutaneous coronary intervention among nondiabetic patients[J].Clin Cardiol,2015,38(3):150-156.DOI:10.1002/clc.22364.
[5]杨建昌,熊宗华,鲁玉明,等.不同剂量瑞舒伐他汀对冠脉造影术后对比剂肾病的影响[J].贵州医药,2014,38(11):1020-1022.DOI:10.3969/j.ISSN.1000-744X.2014.11.023.
[6]Ortega LM,Harmouch I,Nayer A.Contrast-induced nephropathy:pathogenesis and new therapeutic options for prevention[J].Am J Ther,2015,22(6):469-476.DOI:10.1097/MJT.0000000000000163.
[7]Wyatt CM,Camargo M,Coca SG.Prophylactic hydration to prevent contrast-induced nephropathy:much ado about nothing[J]?Kidney Int,2017,92(1):4-6.DOI:10.1016/j.kint.2017.04.005.
[8]Kocas C,Yildiz A,Abaci O,et al.Platelet-to-lymphocyte ratio predicts contrast-induced nephropathy in patients with non-ST-segment elevation acute coronary syndrome[J].Angiology,2015,66(10):964-968.DOI:10.1177/0003319715578057.
[9]Liu Y,Hong D,Wang AY,et al.Effects of intravenous hydration on risk of contrast induced nephropathy and in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention:a systematic review and meta-analysis of randomized controlled trials[J].BMC Cardiovasc Disord,2019,19(1):87.DOI:10.1186/s12872-019-1054-y.
[10]Tang C,Hou J,Yan G,et al.Effects of serum cytochrome Con contrast-induced nephropathy in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention[J].Biomed Res Int,2019,2019:9357203.DOI:10.1155/2019/9357203.
[11]Firouzi A,Kazem Moussavi A,Mohebbi A,et al.Comparison between rosuvastatin and atorvastatin for the prevention of contrast-induced nephropathy in patients with STEMI undergoing primary percutaneous coronary intervention[J].JCardiovasc Thorac Res,2018,10(3):149-152.DOI:10.15171/jcvtr.2018.24.
[12]Gohbara M,Hayakawa A,Akazawa Y,et al.Association between acidosis soon after reperfusion and contrast-induced nephropathy in patients with a first-time ST-segment elevation myocardial infarction[J].J Am Heart Assoc,2017,6(8):e006380.DOI:10.1161/JAHA.117.006380.
[13]Cernigliaro JG,Haley WE,Adolphson DP,et al.Contrast-induced nephropathy in outpatients with preexisting renal impairment:a comparison between intravenous iohexol and iodixanol[J].Clin Imaging,2016,40(5):902-906.DOI:10.1016/j.clinimag.2016.04.008.
[14]Güng?r B,Karatas MB,ipek G,et al.Association of contrast-induced nephropathy with bare metal stent restenosis in STE-MI patients treated with primary PCI[J].Re Fail,2016,38(8):1167-1173.DOI:10.1080/0886022X.2016.1209024.
[15]Ye Z,Lu H,Su Q,et al.Effect of trimetazidine on preventing contrast-induced nephropathy in diabetic patients with renal insufficiency[J].Oncotarget,2017,8(60):102521-102530.DOI:10.18632/oncotarget.19519.
[16]Avci E,Yildirim T,Kadi H.Contrast-induced nephropathy is less common in patients with good coronary collateral circulation[J].Cardiorenal Med,2017,7(4):316-323.DOI:10.1159/000479013.
[17]黄帆,陈波.造影剂肾病发病机制及治疗的研究进展[J].医学综述,2017,23(14):2814-2818.DOI:10.3969/j.issn.1006-2084.2017.14.023.
[18]Patti G,Ricottini E,Nusca A,et al.Short-term,high-dose atorvastatin pretreatment to prevent contrast-induced nephropathy in patients with acute coronary syndromes undergoing percutaneous coronary intervention(from the ARMYDA-CIN[atorvastatin for reduction of myocardial damage during angioplasty--contrast-induced nephropathy]trial[J].Am JCardiology,2011,108(1):1-7.DOI:10.1016/j.amjcard.2011.03.001.
[19]Jo SH,Hahn JY,Lee SY,et al.High-dose atorvastatin for preventing contrast-induced nephropathy in primary percutaneous coronary intervention[J].J Cardiovasc Med(Hagerstown),2015,16(3):213-219.DOI:10.2459/JCM.0000000000000157.
[20]Chu S,Hu L,Wang X,et al.Xuezhikang ameliorates contrast media-induced nephropathy in rats via suppression of oxidative stress,inflammatory responses and apoptosis[J].Ren Fail,2016,38(10):1717-1725.DOI:10.1080/0886022X.2016.1207052.
[21]He X,Li L,Tan H,et al.Atorvastatin attenuates contrastinduced nephropathy by modulating inflammatory responses through the regulation of JNK/p38/Hsp27expression[J].JPharmacol Sci,2016,131(1):18-27.DOI:10.1016/j.jphs.2016.03.006.
[22]Watanabe M,Saito Y,Aonuma K,et al.Prediction of contrast-induced nephropathy by the serum creatinine level on the day following cardiac catheterization[J].J Cardiol,2016,68(5):412-418.DOI:10.1016/j.jjcc.2015.10.016.
[23]Benzer M,Alpay H,Baykan ?,et al.Serum NGAL,cystatin Cand urinary NAG measurements for early diagnosis of contrast-induced nephropathy in children[J].Ren Fail,2015,38(1):27-34.DOI:10.3109/0886022X.2015.1106846.
[24]Kim GS,Ko YG,Shin DH,et al.Elevated serum cystatin Clevel is an independent predictor of contrast-induced nephropathy and adverse outcomes in patients with peripheral artery disease undergoing endovascular therapy[J].J Vasc Surg,2015,61(5):1223-1230.DOI:10.1016/j.jvs.2014.11.079.
[25]Fu M,Dai W,Ye Y,et al.High dose of atorvastatin for the treatment of contrast-induced nephropathy after carotid artery stenting[J].Am J Ther,2017,24(6):e718-e722.DOI:10.1097/MJT.0000000000000407.