中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2014年
7期
35-38
,共4页
杜琳%张晓%朱记法%张由健%郅青
杜琳%張曉%硃記法%張由健%郅青
두림%장효%주기법%장유건%질청
瑞舒伐他汀%阿托伐他汀%急性冠脉综合征%超敏C-反应蛋白
瑞舒伐他汀%阿託伐他汀%急性冠脈綜閤徵%超敏C-反應蛋白
서서벌타정%아탁벌타정%급성관맥종합정%초민C-반응단백
Rosuvastatin%Atorvastatin%Acute coronary syndrome%High-sensitivity C-reactive protein
目的 探讨术前不同剂量瑞舒伐他汀与阿托伐他汀对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后因造影剂引起的肾功能损害的缓解作用及其可能机制.方法 选择PCI的急性冠状动脉综合征(ACS)患者120例,将其分为高剂量瑞舒伐他汀治疗组、高剂量阿托伐他汀治疗组和常规剂量他汀治疗组,每组40例,并检测超敏C-反应蛋白(hs-CRP)、血肌酐(Scr)、尿素氮(BUN)、血清胱抑素C(Cys-C)、尿α1-微球蛋白(α1-MG)、尿微量白蛋白(mALB)、尿渗透压.结果 ①三组患者术前基线资料及冠脉介入情况比较差异无统计学意义(P＞0.05),具有可比性.②术后第1天与术前相比,三组患者BUN、Scr、尿渗透压差异均无统计学意义(P＞0.05),GFR均降低(P＜0.05),CysC、α1-MG、mALB均有明显升高,两高剂量他汀组肾小球滤过率(GFR)降低水平低于常规剂量组,且两高剂量他汀组CysC、α1-MG、mALB升高水平低于常规剂量组,差异有统计学意义(P＜0.05),两高剂量他汀组组间比较差异无统计学意义(P＞0.05);术后第2天与术后第1天相比,三组患者BUN、Scr、尿渗透压差异均无统计学意义(P＞0.05),GFR升高(P＜0.05),CysC、α1-MG、mALB降低,两高剂量他汀组GFR升高水平高于常规剂量组;两高剂量他汀组CysC、α1-MG、mALB水平低于常规剂量组,差异有统计学意义(P＜0.05);两高剂量他汀组组间比较差异无统计学意义(P＞0.05).③hs-CRP在术后第1天与术前相比以及术后第2天与术后第1天相比均有明显升高,差异有统计学意义(P＜0.05);术后第1天与术前相比及术后第2天与术后第1天相比,两高剂量他汀组的hsCRP升高水平明显低于常规剂量组(P＜0.05),两组比较差异无统计学意义(P＞0.05).结论 PCI术前给予高剂量他汀治疗比常规剂量他汀治疗更能有效降低造影剂导致的肾脏功能损伤,其作用机制可能与减轻炎症反应、改善血管内皮功能有关,Cys-C、α1-MG、mALB可作为冠脉介入术后监测早期肾损害的指标.
目的 探討術前不同劑量瑞舒伐他汀與阿託伐他汀對急性冠狀動脈綜閤徵(ACS)患者經皮冠狀動脈介入術(PCI)後因造影劑引起的腎功能損害的緩解作用及其可能機製.方法 選擇PCI的急性冠狀動脈綜閤徵(ACS)患者120例,將其分為高劑量瑞舒伐他汀治療組、高劑量阿託伐他汀治療組和常規劑量他汀治療組,每組40例,併檢測超敏C-反應蛋白(hs-CRP)、血肌酐(Scr)、尿素氮(BUN)、血清胱抑素C(Cys-C)、尿α1-微毬蛋白(α1-MG)、尿微量白蛋白(mALB)、尿滲透壓.結果 ①三組患者術前基線資料及冠脈介入情況比較差異無統計學意義(P＞0.05),具有可比性.②術後第1天與術前相比,三組患者BUN、Scr、尿滲透壓差異均無統計學意義(P＞0.05),GFR均降低(P＜0.05),CysC、α1-MG、mALB均有明顯升高,兩高劑量他汀組腎小毬濾過率(GFR)降低水平低于常規劑量組,且兩高劑量他汀組CysC、α1-MG、mALB升高水平低于常規劑量組,差異有統計學意義(P＜0.05),兩高劑量他汀組組間比較差異無統計學意義(P＞0.05);術後第2天與術後第1天相比,三組患者BUN、Scr、尿滲透壓差異均無統計學意義(P＞0.05),GFR升高(P＜0.05),CysC、α1-MG、mALB降低,兩高劑量他汀組GFR升高水平高于常規劑量組;兩高劑量他汀組CysC、α1-MG、mALB水平低于常規劑量組,差異有統計學意義(P＜0.05);兩高劑量他汀組組間比較差異無統計學意義(P＞0.05).③hs-CRP在術後第1天與術前相比以及術後第2天與術後第1天相比均有明顯升高,差異有統計學意義(P＜0.05);術後第1天與術前相比及術後第2天與術後第1天相比,兩高劑量他汀組的hsCRP升高水平明顯低于常規劑量組(P＜0.05),兩組比較差異無統計學意義(P＞0.05).結論 PCI術前給予高劑量他汀治療比常規劑量他汀治療更能有效降低造影劑導緻的腎髒功能損傷,其作用機製可能與減輕炎癥反應、改善血管內皮功能有關,Cys-C、α1-MG、mALB可作為冠脈介入術後鑑測早期腎損害的指標.
목적 탐토술전불동제량서서벌타정여아탁벌타정대급성관상동맥종합정(ACS)환자경피관상동맥개입술(PCI)후인조영제인기적신공능손해적완해작용급기가능궤제.방법 선택PCI적급성관상동맥종합정(ACS)환자120례,장기분위고제량서서벌타정치료조、고제량아탁벌타정치료조화상규제량타정치료조,매조40례,병검측초민C-반응단백(hs-CRP)、혈기항(Scr)、뇨소담(BUN)、혈청광억소C(Cys-C)、뇨α1-미구단백(α1-MG)、뇨미량백단백(mALB)、뇨삼투압.결과 ①삼조환자술전기선자료급관맥개입정황비교차이무통계학의의(P＞0.05),구유가비성.②술후제1천여술전상비,삼조환자BUN、Scr、뇨삼투압차이균무통계학의의(P＞0.05),GFR균강저(P＜0.05),CysC、α1-MG、mALB균유명현승고,량고제량타정조신소구려과솔(GFR)강저수평저우상규제량조,차량고제량타정조CysC、α1-MG、mALB승고수평저우상규제량조,차이유통계학의의(P＜0.05),량고제량타정조조간비교차이무통계학의의(P＞0.05);술후제2천여술후제1천상비,삼조환자BUN、Scr、뇨삼투압차이균무통계학의의(P＞0.05),GFR승고(P＜0.05),CysC、α1-MG、mALB강저,량고제량타정조GFR승고수평고우상규제량조;량고제량타정조CysC、α1-MG、mALB수평저우상규제량조,차이유통계학의의(P＜0.05);량고제량타정조조간비교차이무통계학의의(P＞0.05).③hs-CRP재술후제1천여술전상비이급술후제2천여술후제1천상비균유명현승고,차이유통계학의의(P＜0.05);술후제1천여술전상비급술후제2천여술후제1천상비,량고제량타정조적hsCRP승고수평명현저우상규제량조(P＜0.05),량조비교차이무통계학의의(P＞0.05).결론 PCI술전급여고제량타정치료비상규제량타정치료경능유효강저조영제도치적신장공능손상,기작용궤제가능여감경염증반응、개선혈관내피공능유관,Cys-C、α1-MG、mALB가작위관맥개입술후감측조기신손해적지표.
Objective To investigate the mitigation effect and possible mechanism of different doses of rosuvastatin and atorvastatin on contrast-induced renal impairment in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI).Methods A total of 120 ACS patients with PCI were divided into three groups:high dose rosuvastatin group (n =40),high dose atorvastatin group (n =40) and the conventional dose group(n =40).The levels of high-sensitivity C-reactive protein (hsCRP),serum creatinine (Scr),blood urea nitrogen (BUN),serum cystatin C (CysC),urinary α1-microglobulin (α1-MG),microalbumin (mALB) and urine osmolality were detected.Results ①The baseline data of the three groups before coronary intervention and their situation has no significant difference (P ＞ 0.05),thus the three groups were comparable.②Compared with the preoperative indeses,the levels of BUN,Scr,urine osmolality in all the three groups on 1 st day after PCI were not significandy different (P ＞ 0.05),the level of GFR decreased (P ＜ 0.05) and the levels of CysC,α1-MG,mALB were significantly increased.The levels of GFR decreased and the levels of CysC,α1-MG,mALB in the two high dose groups were lower than those in the conventional dose group (P ＜ 0.05),but there was no significant difference between the two high dose groups (P ＞ 0.05) ; compared with the indexes on 1 st day after PIC,the levels of BUN,Scr,urine osmolality in all the three groups on 2nd day after PCI were not significantly different (P ＞ 0.05),the level of GFR increased (P ＜ 0.05) and the levels of CysC,α1-MG,mALB decreased.The levels of CysC,α1-MG,mALB in the two high dose groups were lower than those in the conventional dose group (P ＜ 0.05),but there was no significant difference between the two high dose groups (P ＞ 0.05).③The levels of hsCRP on 1 st day after PIC and before operation,on 2nd day after PIC and on 1 st day after PIC were evaluated (P ＜0.05) ; the elevated levels of hsCRP in the two high dose groups were lower than those in the conventional dose group,but there was no significant difference between the two high dose groups (P ＞ 0.05).Conclusions Pretreatment with high dose statins before PIC is more effective on reducing contrast-induced renal impairment than pretreatment with conventional dose stains.The mechanism maybe related to the reduction of inflammation and the improvement of vascular endothelial function; Cys-C,α1-MG,mALB may be used as monitoring indicators of early renal impairment.
