CAJ | 학술논문

目的观察术前联用不同剂量阿托伐他汀与普罗布考对老年冠心病患者对比剂急性肾损伤(CIAKI)和血尿酸的影响.方法接受择期冠状动脉造影(CAG)或经皮冠状动脉支架植入术(PCI)的老年冠心病患者121例,随机分为标准联合剂量治疗(标准联合)组35例:阿托伐他汀每晚顿服20 mg及普罗布考250 mg,3次/d,术前无强化;强化联合剂量治疗(强化联合)组41例:阿托伐他汀每晚顿服40 mg及普罗布考250 mg,3次/d,术前2h顿服阿托伐他汀40 mg普罗布考500 mg;强化剂量治疗(强化)组45例:阿托伐他汀每晚顿服40 mg,术前2h顿服阿托伐他汀40 mg.所有患者术前、术后24 h抽取静脉血检测血尿素、肌酐、尿酸,肾脏病膳食改良试验(MDRD)方法估算肾小球滤过率.留取静脉血和术前清晨第一次中段尿液及术后24 h尿液测定中性粒细胞明胶酶相关脂质运载蛋白(NGAL)浓度.结果 (1)与术前比较,强化联合和强化组术后血尿素均下降,(5.6±1.4)mmol/L与(4.7±0.9) mmol/L、(5.3±1.2) mmol/L与(4.8±1.2)mmol/L(P＜0.01,P＜0.05),血肌酐和肾小球滤过率变化差异无统计学意义;标准联合组术后肾小球滤过率下降,(76.2±14.3)ml· min-1·1.73 m-2与(71.9±17.9) ml·min-1· 1.73 m-2(P＜0.05);术后只有强化联合组血尿酸下降(P＜0.01).(2)标准联合组术后尿NGAL升高,其尿NGAL变化值较其他两组高(均P＜0.01).结论术前联用阿托伐他汀40 mg和普罗布考250 mg,3次/d,或单用阿托伐他汀40 mg,均可改善CIAKI,只有强化联合方式在短期内可降低血尿酸.
목적 관찰술전련용불동제량아탁벌타정여보라포고대노년관심병환자대비제급성신손상(CIAKI)화혈뇨산적영향.방법 접수택기관상동맥조영(CAG)혹경피관상동맥지가식입술(PCI)적노년관심병환자121례,수궤분위표준연합제량치료(표준연합)조35례:아탁벌타정매만돈복20 mg급보라포고250 mg,3차/d,술전무강화;강화연합제량치료(강화연합)조41례:아탁벌타정매만돈복40 mg급보라포고250 mg,3차/d,술전2h돈복아탁벌타정40 mg보라포고500 mg;강화제량치료(강화)조45례:아탁벌타정매만돈복40 mg,술전2h돈복아탁벌타정40 mg.소유환자술전、술후24 h추취정맥혈검측혈뇨소、기항、뇨산,신장병선식개량시험(MDRD)방법고산신소구려과솔.류취정맥혈화술전청신제일차중단뇨액급술후24 h뇨액측정중성립세포명효매상관지질운재단백(NGAL)농도.결과 (1)여술전비교,강화연합화강화조술후혈뇨소균하강,(5.6±1.4)mmol/L여(4.7±0.9) mmol/L、(5.3±1.2) mmol/L여(4.8±1.2)mmol/L(P＜0.01,P＜0.05),혈기항화신소구려과솔변화차이무통계학의의;표준연합조술후신소구려과솔하강,(76.2±14.3)ml· min-1·1.73 m-2여(71.9±17.9) ml·min-1· 1.73 m-2(P＜0.05);술후지유강화연합조혈뇨산하강(P＜0.01).(2)표준연합조술후뇨NGAL승고,기뇨NGAL변화치교기타량조고(균P＜0.01).결론 술전련용아탁벌타정40 mg화보라포고250 mg,3차/d,혹단용아탁벌타정40 mg,균가개선CIAKI,지유강화연합방식재단기내가강저혈뇨산.
Objective To observe the effect of different doses of atorvastatin combined with probucol on contrast induced acute kidney injury (CIAKI) and serum uric acid in elderly patients.Methods Totally 121 cases admitted for coronary angioplasty were randomly divided into three groups.In standard combining treatment group (n＝35),atorvastatin 20 mg qn and probucol 0.25 g,tid were given with no loading dose intake before angioplasty.In intensively combined treatment group (n＝41),atorvastatin 40mg qn and probucol 0.25 g,tid were given with a loading dose of atorvastatin 40 mg and probucol 0.5 g at 2 hours before angioplasty.In intensive atorvastatin therapy group(n＝45),atorvastatin 40 mg qn were given,with a loading dose of atorvastatin 40 mg 2 hours before angioplasty.All patients were then evaluated 24 hours before and after angioplasty procedure,and their blood urea nitrogen (BUN),serum creatinine (Scr),serum uric acid (SUA),estimated glomerular filtration rate (eGFR) by modified diet in renal disease study (MDRD) method were tested.The serum and urine at 24 hours before and after operation were collected.Neutrophil gelatinase associated lipocalin (NGAL) were determinated by enzyme linked immunosorbnent assay (ELISA) method.Results After operation,eGFR was decreased in standard combining treatment group [(76.2±14.3) ml· min-1 · 1.73 m-2 vs.(71.9±17.9) ml· min-1 · 1.73 m-2,P＜0.05],while Scr,eGFR and uNGAL showed no changes in intensively combining treatment group and intensive atorvastatin therapy group (P＞0.05) ; BUN in the two groups was decreased [(5.6± 1.4)mmol/L vs.(4.7±0.9) mmol/L,(5.3±1.2) mmol/L vs.(4.8±1.2) mmol/L,P＜0.01,P＜0.05].SUA was reduced in intensively combining treatment group (P ＜ 0.05).uNGAL was increased in standard combining treatment group (P ＜ 0.05).Conclusions For elderly patients,intensive atorvastatin therapy and combining intensive treatment can both improve CIAKI.Only combination and intensive treatment benefit for decrease of uric acid.