中国循环杂志
中國循環雜誌
중국순배잡지
Chinese Circulation Journal
2015年
9期
845-848
,共4页
经皮冠状动脉介入治疗%阿托伐他汀%对比剂肾病%热休克蛋白90%一氧化氮
經皮冠狀動脈介入治療%阿託伐他汀%對比劑腎病%熱休剋蛋白90%一氧化氮
경피관상동맥개입치료%아탁벌타정%대비제신병%열휴극단백90%일양화담
Percutaneous coronary intervention%Atorvastatin%Contrast-induced nephropathy%Heat shock protein 90%Nitrogen monoxide
目的：探讨高剂量阿托伐他汀通过促进热休克蛋白90（HSP90）表达，减少急诊经皮冠状动脉介入治疗（PCI）术后患者对比剂肾病的发生及可能的机制。方法：入选158例急性ST段抬高型心肌梗死行急诊PCI的患者，随机分为高剂量组（80例，术前给予阿托伐他汀40 mg）和对照组（78例，术前给予安慰剂），比较阿托伐他汀治疗后两组患者血清肌酐、尿素氮、肌酐清除率，对比剂肾病发病率，尿a1微球蛋白、血浆丙二醛、超氧化物歧化酶、一氧化氮、HSP90及其mRNA表达量的变化。结果：与对照组比较，高剂量组术后血清肌酐[（68.92±8.80）μmol/L vs (77.25±13.36)μmol/L]、血浆丙二醛[(3.88±0.53) nmol/L vs (4.08±0.52) nmol/L]、尿α1微球蛋白水平[（1.38±0.36） mg/dl vs (1.89±1.13）mg/dl]均降低；血清肌酐清除率[(89.71±9.85) ml/min vs (77.28±13.78) ml/min]、血浆超氧化物歧化酶[(129.52±30.63) U/ml vs (117.66±27.98) U/ml]、一氧化氮水平[(66.23±29.26)μmol/gprot vs (55.12±27.43)μmol/gprot]均升高，差异均有统计学意义（P均<0.05）；高剂量组术后血浆HSP90的浓度[(1259.83±121.17) pg/ml vs (1195.0±127.65) pg/ml]和血浆HSP90的mRNA相对表达量(0.466±0.158 vs 0.224±0.278)均较对照组升高，差异均有统计学意义（P<0.05）。高剂量组对比剂肾病发生率（2.5%）低于对照组（10.3%），两组比较差异有统计学意义（P<0.05）。结论：急诊PCI术前强化阿托伐他汀治疗可减少对比剂肾病的发生；阿托伐他汀可能通过促进HSP90表达，增加一氧化氮产生，改善血管内皮细胞功能、抗氧化应激来保护肾功能，减少对比剂肾病的发生。
目的：探討高劑量阿託伐他汀通過促進熱休剋蛋白90（HSP90）錶達，減少急診經皮冠狀動脈介入治療（PCI）術後患者對比劑腎病的髮生及可能的機製。方法：入選158例急性ST段抬高型心肌梗死行急診PCI的患者，隨機分為高劑量組（80例，術前給予阿託伐他汀40 mg）和對照組（78例，術前給予安慰劑），比較阿託伐他汀治療後兩組患者血清肌酐、尿素氮、肌酐清除率，對比劑腎病髮病率，尿a1微毬蛋白、血漿丙二醛、超氧化物歧化酶、一氧化氮、HSP90及其mRNA錶達量的變化。結果：與對照組比較，高劑量組術後血清肌酐[（68.92±8.80）μmol/L vs (77.25±13.36)μmol/L]、血漿丙二醛[(3.88±0.53) nmol/L vs (4.08±0.52) nmol/L]、尿α1微毬蛋白水平[（1.38±0.36） mg/dl vs (1.89±1.13）mg/dl]均降低；血清肌酐清除率[(89.71±9.85) ml/min vs (77.28±13.78) ml/min]、血漿超氧化物歧化酶[(129.52±30.63) U/ml vs (117.66±27.98) U/ml]、一氧化氮水平[(66.23±29.26)μmol/gprot vs (55.12±27.43)μmol/gprot]均升高，差異均有統計學意義（P均<0.05）；高劑量組術後血漿HSP90的濃度[(1259.83±121.17) pg/ml vs (1195.0±127.65) pg/ml]和血漿HSP90的mRNA相對錶達量(0.466±0.158 vs 0.224±0.278)均較對照組升高，差異均有統計學意義（P<0.05）。高劑量組對比劑腎病髮生率（2.5%）低于對照組（10.3%），兩組比較差異有統計學意義（P<0.05）。結論：急診PCI術前彊化阿託伐他汀治療可減少對比劑腎病的髮生；阿託伐他汀可能通過促進HSP90錶達，增加一氧化氮產生，改善血管內皮細胞功能、抗氧化應激來保護腎功能，減少對比劑腎病的髮生。
목적：탐토고제량아탁벌타정통과촉진열휴극단백90（HSP90）표체，감소급진경피관상동맥개입치료（PCI）술후환자대비제신병적발생급가능적궤제。방법：입선158례급성ST단태고형심기경사행급진PCI적환자，수궤분위고제량조（80례，술전급여아탁벌타정40 mg）화대조조（78례，술전급여안위제），비교아탁벌타정치료후량조환자혈청기항、뇨소담、기항청제솔，대비제신병발병솔，뇨a1미구단백、혈장병이철、초양화물기화매、일양화담、HSP90급기mRNA표체량적변화。결과：여대조조비교，고제량조술후혈청기항[（68.92±8.80）μmol/L vs (77.25±13.36)μmol/L]、혈장병이철[(3.88±0.53) nmol/L vs (4.08±0.52) nmol/L]、뇨α1미구단백수평[（1.38±0.36） mg/dl vs (1.89±1.13）mg/dl]균강저；혈청기항청제솔[(89.71±9.85) ml/min vs (77.28±13.78) ml/min]、혈장초양화물기화매[(129.52±30.63) U/ml vs (117.66±27.98) U/ml]、일양화담수평[(66.23±29.26)μmol/gprot vs (55.12±27.43)μmol/gprot]균승고，차이균유통계학의의（P균<0.05）；고제량조술후혈장HSP90적농도[(1259.83±121.17) pg/ml vs (1195.0±127.65) pg/ml]화혈장HSP90적mRNA상대표체량(0.466±0.158 vs 0.224±0.278)균교대조조승고，차이균유통계학의의（P<0.05）。고제량조대비제신병발생솔（2.5%）저우대조조（10.3%），량조비교차이유통계학의의（P<0.05）。결론：급진PCI술전강화아탁벌타정치료가감소대비제신병적발생；아탁벌타정가능통과촉진HSP90표체，증가일양화담산생，개선혈관내피세포공능、항양화응격래보호신공능，감소대비제신병적발생。
Objective: To explore the high dose atorvastatin reducing contrast induced nephropathy (CIN) rate in patiens with emergent percutaneous coronary intervention (PCI) via improveing heat shock protein-90 (HSP90) expression with its possible mechanism. Methods: A total of 158 STEMI patients with emergent PCI in our hospital were studied. The patients were randomly divided into 2 groups: High dose atorvastatin group, the patients received pre-operative atorvastatin 40 mg,n=80 and Control group, the patients received pre-operative placebo,n=78. The serum creatinin (Scr), creatinine clearance rate (Ccr), blood urea nitrogen (BUN), superoxide dismutase (SOD), malondialdehyde (MDA), nitrogen monoxide (NO), HSP90 mRNA expression and protein concentration and urine α1-microglobulin were examined in all patients and the incidence rates of CIN were compared between 2 groups. Results: Compared with Control group, High dose atorvastatin group had drcreased Scr (68.92 ± 8.80) μmol/L vs (77.25 ± 13.36) μmol/L, MDA (3.88 ± 0.53) nmol/L vs (4.08 ± 0.52) nmol/L and urine α1-micrglobulin (1.38 ± 0.36) mg/dl vs (1.89 ± 1.13 ) mg/dl; increased Ccr (89.71 ± 9.85) ml/min vs (77.28 ± 13.78) ml/ min, SOD (129.52 ± 30.63) U/ml vs (117.66 ± 27.98) U/ml, NO (66.23 ± 29.26) μmol?gprot vs (55.12±27.43) μmol?gprot, allP<0.05. Compared with Control group, High dose atorvastatin group presented higher post-operative HSP90 mRNA expression (0.466 ± 0.158) vs (0.224 ± 0.278 ) and protein concentration (1259.83 ± 121.17) pg/ml vs (1195.0 ± 127.65) pg/ml, allP<0.05. The incidence rate of CIN was lower in High dose atorvastatin group (2.5%) than Control group (10.3%),P<0.05. Conclusion: A high dose atorvastatin administration before emergent PCI may decrease CIN occurrence rate. Atorvastatin may promote HSP90 expression, increase NO produciton, then improve the vascular endothelial function and anti-oxidative ability to protect the renal function in STEMI patients.
