CAJ | 학술논문

目的：观察阿托伐他汀对老年糖尿病患者行造影术后肾功能的影响。方法60例拟行造影术的老年糖尿病患者随机分为对照组、20 mg阿托伐他汀组和40 mg阿托伐他汀组各20例。20 mg、40 mg阿托伐他汀组于造影术前3 d每晚分别顿服阿托伐他汀20 mg、40 mg，对照组未服用阿托伐他汀及其他调脂类药。观察患者造影前、造影后2、7 d血清肌酐（Scr）、胱抑素C （Cys C）、肌酐清除率（Ccr）、尿视黄醇结合蛋白（RBP）、超敏C反应蛋白（hs-CRP）的改变情况。结果①造影后2 d，对照组Scr升高明显，Ccr下降，与术前比较有统计学意义（P＜0.05），并出现1例造影剂肾病。②造影后2 d，3组血Cys C、hs-CRP、尿RBP均明显升高，对照组升高尤为明显，20 mg他汀组次之，40 mg他汀组升幅最小，3组比较差异均有统计学意义（P＜0.05）。③与术后2 d相比，术后7 d，3组Cys C、hs-CRP、尿RBP均下降，40 mg他汀组最接近基线水平，20 mg他汀组次之，3组比较差异均有统计学意义（P＜0.05）。结论老年糖尿病患者造影前3 d应用阿托伐他汀能改善造影剂引起的肾功能损害，可能具有剂量依赖性，其机制可能与阿托伐他汀抗炎和改善血管内皮功能有关。血清Cys C、尿RBP可作为造影剂肾病早期肾损伤的灵敏检测指标。
목적：관찰아탁벌타정대노년당뇨병환자행조영술후신공능적영향。방법60례의행조영술적노년당뇨병환자수궤분위대조조、20 mg아탁벌타정조화40 mg아탁벌타정조각20례。20 mg、40 mg아탁벌타정조우조영술전3 d매만분별돈복아탁벌타정20 mg、40 mg，대조조미복용아탁벌타정급기타조지류약。관찰환자조영전、조영후2、7 d혈청기항（Scr）、광억소C （Cys C）、기항청제솔（Ccr）、뇨시황순결합단백（RBP）、초민C반응단백（hs-CRP）적개변정황。결과①조영후2 d，대조조Scr승고명현，Ccr하강，여술전비교유통계학의의（P＜0.05），병출현1례조영제신병。②조영후2 d，3조혈Cys C、hs-CRP、뇨RBP균명현승고，대조조승고우위명현，20 mg타정조차지，40 mg타정조승폭최소，3조비교차이균유통계학의의（P＜0.05）。③여술후2 d상비，술후7 d，3조Cys C、hs-CRP、뇨RBP균하강，40 mg타정조최접근기선수평，20 mg타정조차지，3조비교차이균유통계학의의（P＜0.05）。결론노년당뇨병환자조영전3 d응용아탁벌타정능개선조영제인기적신공능손해，가능구유제량의뢰성，기궤제가능여아탁벌타정항염화개선혈관내피공능유관。혈청Cys C、뇨RBP가작위조영제신병조기신손상적령민검측지표。
Objective Toobservetheinfluenceofatorvastatinonrenalimpairmentinagedpatients withdiabetesmellitus(DM)causedbycontrastagentsafterangiography.Methods Atotalof60elderlyDM patients requiring angiography were prospectively enrolled and randomly assigned to the atorvastatin groups (20 mg/qn,n=20;40 mg/qn,n=20)and control group (n=20). Patients in the atorvastatin groups received atorvastatin for three days before angiography and those in the control group had no atorvastatin or other statins.The levels of high sensitivity C-reactive protein (hs-CRP),cystain C (Cys C),serum creatinine (Scr)and u-rinary retinal binding protein (RBP)were detected and creatinine clearance rate (Ccr)was calculated before and on the 2nd and 7th days after angiography,respectively. Results ①In the control group,serum level of creatinine was increased whereas Ccr was decreased on the 2nd day after angiography compared the levels be-fore angiography (both P<0.05 ). One patient presented with contrast agent-induced nephropathy. ② Among all three groups,serum levels of Cys C,hs-CRP and urinary RBP were significantly elevated on the 2nd day af-ter angiography (all P<0.05 ). The largest increase was noted in the control group followed by 20 mg-and 40 mg-atorvastatin groups. ③ The levels of serum Cys C,hs-CRP and urinary RBP in all three groups were de-creased on the 7th day after angiography while the level in the 40 mg-atorvastatin group was similar to baseline level(allP<0.05).Conclusion PretreatmentwithatorvastatinforthreedaysforagedDMpatientsbefore angiography can effectively alleviate the renal impairment caused by contrast agents probably in a dose-depend-ent manner.This effect is possibly associated with the mechanisms of anti-inflammation and improving vascular endothelial function.Serum levels of Cys C and urinary RBP could serve as sensitive indexes for early renal damages caused by contrast agents.