CAJ | 학술논문

目的探讨前列腺素E1(PGE1)对行冠状动脉造影(CAG)或经皮冠状动脉介入治疗术(PCI)老年人的肾脏保护作用.方法拟行CAG或PCI的患者161例,数字抽签随机分为PGE1组(87例)和对照组(74例).PGE1组患者术前5d至术后2d用脂微球PGE110μg加入生理盐水100ml中静脉滴注,1次/d.人院和术后48 h查血肌酐和胱抑素C(Cys C)水平.结果与PGE1组比较,对照组术后血肌酐水平和血清Cys C水平升高(均P＜0.01)；而肌酐清除率(Ccr)降低(P＜0.05).对照组对比剂诱导的急性肾损伤(CI-AKI)发生率高于PGE1组,分别为12.2％(9/74)和3.4％(3/87),差异有统计学意义(P＜0.05).Logistic回归分析结果显示,使用PGE1可降低CI-AKI 发生率；而高基线水平的血肌酐、糖尿病增加CI-AKI发生率.血清Cys C水平与Ccr呈负相关(r=-0.615,P＜0.01).结论围术期应用P(GE1对行CAG或PCI的老年人具有肾脏保护作用,并能降低CI-AKI的发生率.血清Cys C水平可作为CI-AKI的辅助诊断指标之一.
목적 탐토전렬선소E1(PGE1)대행관상동맥조영(CAG)혹경피관상동맥개입치료술(PCI)노년인적신장보호작용.방법 의행CAG혹PCI적환자161례,수자추첨수궤분위PGE1조(87례)화대조조(74례).PGE1조환자술전5d지술후2d용지미구PGE110μg가입생리염수100ml중정맥적주,1차/d.인원화술후48 h사혈기항화광억소C(Cys C)수평.결과 여PGE1조비교,대조조술후혈기항수평화혈청Cys C수평승고(균P＜0.01)；이기항청제솔(Ccr)강저(P＜0.05).대조조대비제유도적급성신손상(CI-AKI)발생솔고우PGE1조,분별위12.2％(9/74)화3.4％(3/87),차이유통계학의의(P＜0.05).Logistic회귀분석결과현시,사용PGE1가강저CI-AKI 발생솔；이고기선수평적혈기항、당뇨병증가CI-AKI발생솔.혈청Cys C수평여Ccr정부상관(r=-0.615,P＜0.01).결론 위술기응용P(GE1대행CAG혹PCI적노년인구유신장보호작용,병능강저CI-AKI적발생솔.혈청Cys C수평가작위CI-AKI적보조진단지표지일.
Objective To investigate the nephroprotective effects of prostaglandin E1 (PGE1) in the elderly undergoing coronary angiography or intervention. Methods 161 patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) were randomly assigned to PGE1 group (n=87 cases) and control group (n=74 cases).10 μg lipo-PGE1 added to 100 ml normal saline were administered intravenously once daily for 5 days before and 2 days after the operation.The serum levels of creatinine (Scr) and cystatin C (Cys C) were measured on admission and 48 h after the procedure.Results After the procedure,the levels of Scr and Cys C were increased (P＜0.01) and creatinine clearance (Ccr) was decreased (P＜0.05) in control group than in PGE1 group.The incidence of contrast-induced acute kidney injury (CI-AKI) in control group 〔12.2％ (9/74)〕 was higher than in PGE1 group 〔3.4％(3/87)〕 (P＜0.05).The application of P(GE1 decreased CI-AKI,but high basic level of Scr and diabetes mellitus enhanced the incidence of CI-AKI by logistic regression.The serum levels of Cys C had negative correlation with Ccr (r=-0.615,P＜0.01).Conclusions Perioperative application of PGE1 has nephroprotective effects in the elderly undergoing CAG or PCI,and decreases the incidence of CI-AKI.The serum levels of Cys C is one of ideal indexes for auxiliary diagnosis of CI-AKI.