CAJ | 학술논문

目的探讨强化剂量阿托伐他汀对老年冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)术后造影剂肾病( CIN)的预防作用.方法将100例年龄＞60岁的行冠脉介入治疗的CHD患者随机分为观察组和对照组,每组50例.在全部采用水化治疗基础上,观察组给予强化剂量阿托伐他汀,对照组给予常规剂量阿托伐他汀.术前、术后测定血清肌酐(Scr)、血β2-微球蛋白(β2-MG)、肝功能等指标,按Cochcroft-Gault公式计算内生肌酐清除率(Ccr)；记录住院期间和随访期间30d内主要不良心脏事件(MACE)发生率及肝毒性和肌毒性发生情况.结果术后第1、3天观察组Ccr显著高于对照组[(73.12±16.89)ml/min比(63.89±18.42)ml/min,P=0.036]、[(65.32±13.46) ml/min比(55.63±15.47) ml/min,P=0.021]；术后第1、2、3d观察组β2-MG显著低于对照组[( 2.44±0.42) ml/min比(2.69±0.63) ml/min,P=0.009]、[(2.52±0.46) ml/min比(2.81±0.63) ml/min,P=0.011]、[(2.37±0.43) ml/min比(2.54±0.65) ml/min,P=0.021]；观察组CIN发生率显著低于对照组(分别为6％和24％,P=0.012)；随访30 d内,共14例(14％)患者发生MACE,其中观察组3例(6％),对照组11例(22％)(x2=5.316,P=0.021)；两组均无肌毒性和肝毒性发生.结论 PCI术前服用强化剂量阿托伐他汀对老年患者CIN的发生可能有更好的预防作用,且较为安全.
목적 탐토강화제량아탁벌타정대노년관심병(CHD)환자경피관상동맥개입치료(PCI)술후조영제신병( CIN)적예방작용.방법 장100례년령＞60세적행관맥개입치료적CHD환자수궤분위관찰조화대조조,매조50례.재전부채용수화치료기출상,관찰조급여강화제량아탁벌타정,대조조급여상규제량아탁벌타정.술전、술후측정혈청기항(Scr)、혈β2-미구단백(β2-MG)、간공능등지표,안Cochcroft-Gault공식계산내생기항청제솔(Ccr)；기록주원기간화수방기간30d내주요불양심장사건(MACE)발생솔급간독성화기독성발생정황.결과 술후제1、3천관찰조Ccr현저고우대조조[(73.12±16.89)ml/min비(63.89±18.42)ml/min,P=0.036]、[(65.32±13.46) ml/min비(55.63±15.47) ml/min,P=0.021]；술후제1、2、3d관찰조β2-MG현저저우대조조[( 2.44±0.42) ml/min비(2.69±0.63) ml/min,P=0.009]、[(2.52±0.46) ml/min비(2.81±0.63) ml/min,P=0.011]、[(2.37±0.43) ml/min비(2.54±0.65) ml/min,P=0.021]；관찰조CIN발생솔현저저우대조조(분별위6％화24％,P=0.012)；수방30 d내,공14례(14％)환자발생MACE,기중관찰조3례(6％),대조조11례(22％)(x2=5.316,P=0.021)；량조균무기독성화간독성발생.결론 PCI술전복용강화제량아탁벌타정대노년환자CIN적발생가능유경호적예방작용,차교위안전.
Objective To investigate the effect of intensive dose atorvastatin on preventive contrast-induced nephropathy (CIN) in elder with coronary heart disease (CHD) after elective percutaneous coronary intervention (PCI).Methods 110 subjects older than 60 who received elective PCI,were randomly divided into intensive dose atorvastatin group (the study group,n =50) and conventional treatment group (the control group,n =50).On the ba sis of the hydration therapy,the study group received atorvastatin and the control group received atorvastatin.Scr、β2- MG and liver function were checked for evidence of tubular or glomemlar damage before and after elective PCI were compared between the two groups.Ccr was calculated according to Cockcroft-Gault formula;The incidence of the major adverse cardiovascular events (MACE) and cytotoxicity and hepatotoxicity of rosuvastation were respectively recorded in 30 days follow-up period.Results Ccr in the study group was significantly higher than that in the control group at day 1 [( 73.12 ± 16.89 ) ml/min vs ( 63.89 ± 18.42 ) ml/min,P =0.036],day 2 [( 65.32 ± 13.46 ) ml/min vs (55.63 ± 15.47 )mL/min,P =0.021] ;Blood β2-M in the study group was significantly lower than that in the control group at day 1 [( 2.44 ± 0.42 ) ml/min vs ( 2.69 ± 0.63 ) mL/min,P =0.009],day 3 ( 2.52 ± 0.46 ) mL/min vs (2.81 ±0.63) ml/min,P =0.011],day 3[(2.37 ±0.43) ml/min vs (2.54 ±0.65 ) ml/min,P =0.021].The incidence of CIN was lower in the study group than that in the control group(6％ vs 24％,P =0.012).During 30days clinical follow-up,the incidence of the MACE in the control group was more than the study group ( x2 =5.316,P =0.021).There was no significant difference between the two groups for the cytotoxicity and hepatotoxicity.Conclusion High dose atorvastatin may be more efficient in prevention CIN in elder before elective PCI and this higher dose may be safe to the elder.