不同他汀药物短期、大剂量应用对行冠状动脉介入治疗患者肾功能的保护作用

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摘要目的探讨不同的他汀药物短期、大剂量应用对行冠脉介入治疗的患者术后肾功能的影响及其可能的机制。方法选择2015年3月～2016年3月在徐州市中心医院心内科行冠脉介入治疗的患者180例，按随机数字表法将其随机分为瑞舒伐他汀组、阿托伐他汀组和对照组，每组各60例。术前3 d至术后3 d，瑞舒伐他汀组给予瑞舒伐他汀20 mg/d治疗，阿托伐他汀组给予阿托伐他汀80 mg/d治疗，对照组不给予任何他汀药物治疗。三组患者术前、术后48～72 h采血测定血肌酐和超敏C反应蛋白水平，比较三组对比剂肾病的发生率、术前及术后超敏C反应蛋白水平。结果瑞舒伐他汀组和阿托伐他汀组对比剂肾病发病率明显低于对照组，差异有统计学意义（P ＜ 0.05），瑞舒伐他汀组与阿托伐他汀组比较，差异无统计学意义（P ＞ 0.05）。瑞舒伐他汀组和阿托伐他汀组术后超敏C反应蛋白升高程度均低于对照组，差异有统计学意义（P ＜ 0.05），但瑞舒伐他汀组和阿托伐他汀组比较，差异无统计学意义（P ＞ 0.05）。结论瑞舒伐他汀和阿托伐他汀短期、大剂量应用可以降低对比剂肾病的发病率，并且可以降低术后超敏C反应蛋白的升高。

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	娄明1 宫海滨2 刘奕1 王璐璐1 曹秋玫1

关键词 ：经皮冠状动脉介入治疗, 他汀, 对比剂肾病, 血肌酐, 超敏C反应蛋白

Abstract：Objective To investigate the effect of short-term and high dose of different statins on the renal function of patients underwent percutaneous coronary intervention and its possible mechanism. Methods One hundred and eighty patients underwent percutaneous coronary intervention in Department of Cardiology, Xuzhou Central Hospital from March 2015 to March 2016 were selected, and they were randomly divided into Rosuvastatin group, Atorvastatin group, and control group according to the random number table, with 60 cases in each group. From 3 d before operation to 3 d after operation, Rosuvastatin group was treated with 20 mg/d, Atorvastatin group was treated with Atorvastatin 80 mg/d, the control group was not given any statins. Before operation and 48-72 h after operation, the blood of three groups was draw to detect the levels of serum creatinine and hypersensitive C-reactive protein. The incidence of contrast-induced nephropathy and the levels of hypersensitive C-reactive protein among the three groups were compared. Results The incidence of contrast-induced nephropathy in Rosuvastatin group and Atorvastatin group was lower than that of control group, there were statistically significant differences (P ＜ 0.05), while there was no statistically significant difference between Rosuvastatin group and Atorvastatin group (P ＞ 0.05). The increased degree of postoperative hypersensitive C-reactive protein in Rosuvastatin group and Atorvastatin group was lower than that of control group, there were statistically significant differences (P ＜ 0.05), while there was no statistically significant difference between Rosuvastatin group and Atorvastatin group (P ＞ 0.05). Conclusion Short-term and high dose of Rosuvastatin and Atorvastatin can decrease the incidence of contrast-induced nephropathy and the increase of postoperative hypersensitive C-reactive protein.

Key words： Percutaneous coronary intervention Statin Contrast-induced nephropathy Serum creatinine Hypersensitive C-reactive protein

基金资助:江苏省徐州市科学技术局社会发展基金项目（XZZD1379）。

作者简介: 娄明（1977.4-），男，硕士，副主任医师；研究方向：冠心病介入治疗。

引用本文:

娄明1 宫海滨2 刘奕1 王璐璐1 曹秋玫1. 不同他汀药物短期、大剂量应用对行冠状动脉介入治疗患者肾功能的保护作用[J]. 中国医药导报, 2017, 14(29): 57-60.
LOU Ming1 GONG Haibin2 LIU Yi1 WANG Lulu1 CAO Qiumei1. Protective effect of short-term and high dose of different statins for the renal function of patients underwent percutaneous coronary intervention. 中国医药导报, 2017, 14(29): 57-60.

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[1] Nash K，Hafeez A，Hou S. Hospital-acquired renal insufficiency [J]. Am J Kidney Dis，2002，39（5）：930-936.
[2] Gleeson TG，Bulugahapitiya S. Contrast-induced nephropathy：Review [J]. AJR，2004，183：1673-1689.
[3] McCullough PA，Choi JP，Feghali GA. Contrast-Induced Acute Kidney Injury [J]. J Am Coll Cardiol，2016，68（13）：1465-1473.
[4] Heinrich MC，Kuhlmann MK，Grgic A，et al. Cytotoxic effects of ionic high-osmolar，nonionic monomeric，and nonionic iso-osmolar dimeric iodinated contrast media on renal tubular cells in vitro [J]. Radiology，2005，235（3）：843-849.
[5] Ozkok S，Ozkok A.Contrast-induced acute kidney injury：A review of practical points [J]. World J Nephrol，2017，6（3）：86-99.
[6] Fahling M，Seeliger E，Patzak A，et al. Understanding and preventing contrast-induced acute kidney injury [J]. Nat Rev Nephrol，2017，13（3）：169-180.
[7] 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 J Cardiol，2011，108（1）：1-7.
[8] Su X，Xie X，Liu L，et al. Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced AcuteKidney Injury：A Systematic Review and Bayesian Network Meta-analysis [J]. Am J Kidney Dis，2017，69（1）：69-77.
[9] Syed MH，Khandelwal PN，Thawani VR，et al. Efficacy of Atorvastatin in Prevention of Contrast-induced Nephropathy in High-risk Patients Undergoing Angiography：A Double-blind Randomized Controlled Trial [J]. J Pharmacol Pharmacother，2017，8（2）：50-53.
[10] Ilan Goldenberg，Shlomi Matetzky. Nephropathy induced by contrast media：pathogenesis，risk factors and preventive strategies [J]. Can Med Assoc，2005，172（11）：1461.
[11] Tumlin J，Stacul F，Adam A，et al. Pathophysiology of contrast induced nephropathy [J]. Am J Cardio，2006，98（6A）：14.
[12] Hogstrom B，Ikei N. Physicochemical properties of radiographic contrast media，potential nephrotoxicity and prophylaxis [J]. Clin Exp Pharmacol Physiol，2015，42（12）：1251-1257.
[13] Wichmann JL，Katzberg RW，Litwin SE，et al. Contrast-Induced Nephropathy [J]. Circulation，2015，132（20）：1931-1936.
[14] Ichiki T，Takeda K，Tokunou T，et al. Downregulation of angiotensin 11 type 1 receptor by hydrophobic 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors in vascular smooth muscle cells [J]. Arterioscler Thromb Vasc Biol，2001，21（3）：1896-1901.
[15] Sabbatini M，Pisani A，Uccello F，et al. Atorvastatin improves the course of ischemic acute renal failure in aging rats [J]. J Am Soc Nephrol，2004，15（4）：901-909.
[16] Xinwei J，Xianghua F，Jing Z，et al. Comparison of usefulness of simvastatin 20 mg versus 80 mg in preventing contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention [J]. Am J Cardiol，2009，104（16）：519-524.
[17] 邵磊，董静，海冰峰，等.阿托伐他汀预防对比剂肾损害的随机化临床研究[J].医药论坛杂志，2011，32（5）：95.
[18] 张东亚，朱静，陈建昌，等.阿托伐他汀对造影剂肾病的预防作用[J].苏州大学学报，2011，31（2）：290.
[19] 汪斌，刘志忠，张丰富，等.冠状动脉介入诊治中高敏C反应蛋白与造影剂肾病的相关性分析[J].中国医药，2007， 2（8）：457-459.
[20] 苏津自，薛艳，蔡文钦，等.高敏C反应蛋白水平与阿托伐他汀对急性冠状动脉综合征患者对比剂所致肾功能损害影响的关系[J].中华心血管病杂志，2011，39（9）：807-811.
[21] Dasari TW，Cohen DJ，Kleiman NS，et al. Statin therapy in patients with chronic kidney disease undergoing percutaneous coronary intervention（from the Evaluation of Drug Eluting Stents and Ischemic Events Registry）[J]. Am J Cardiol，2014，113（4）：621-625.
[22] Leoncini M，Toso A，Maioli M，et al. Early high-dose rosuvastatin for contrast-induced nephropathy prevention in acute coronary syndrome：Results from the PRATO-ACS Study（Protective Effect of Rosuvastatin and Antiplatelet Therapy On contrast-induced acute kidney injury and myocardial damage in patients with Acute Coronary Syndrome）[J]. J Am Coll Cardiol，2014，63（1）：71-79.
[23] Kaneko H，Yajima J，Oikawa Y，et al. Effects of statin treatment in patients with coronary artery disease and chronic kidney disease [J]. Heart Vessels，2014，29（1）：21-28.
[24] Patti G，Leoncini M，Toso A，et al. Impact of high-dose statin pre-treatment and contrast-induced acute kidney injury on follow-up events in patients with acute coronary syndrome undergoing percutaneous coronary intervention [J]. Int J Cardiol，2014，174（2）：440-441.
[25] Cheungpasitporn W，Thongprayoon C，Kittanamongkolchai W，et al. Periprocedural effects of statins on the incidence of contrast-induced acute kidney injury：a systematic review and meta-analysis of randomized controlled trials [J]. Ren Fail，2015，37（4）：664-671.