【摘要】 目的研究术前强化阿托伐他汀治疗在预防对比剂肾病中的作用。方法选取2010年8月至2011年2月期间我院60例行冠状动脉介入诊断与治疗的患者随机分为强化治疗组(A组)和常规剂量组(B组),每组患者各30例。全部采用标准水化治疗[0.9%NaCl溶液1ml/(kg·h)静脉水化12h,并鼓励患者多饮水]和给予阿托伐他汀10mg/d的基础上,强化治疗组术前24～72h予阿托伐他汀40mg口服.观察术前和术后1、3、7d血清肌酐(Scr)、内生肌酐清除率(Ccr)、血β2-微球蛋白(β2-Mg)、胱抑素C、高敏C反应蛋白(hs-CRP)的改变情况、记录术中造影剂的用量以及有无不良反应的发生。结果术后第1、3天,两组Ccr与术前相比明显下降,血肌酐、β2-微球蛋白、胱抑素C、hs-CRP分别与术前比较明显升高(P<0.05),组间比较,A组Ccr较B组高,差异有统计学意义,血肌酐、β2-Mg、胱抑素C、hs-CRP明显低于B组(P<0.05)。术后第7天,A、B两组肌酐、Ccr、血β2-微球蛋白、胱抑素C、hs-CRP与术前相比无差异。A组对比剂肾病发生率为0,B组出现1例,占3.33%。结论对比剂可能造成轻微一过性肾损害,术前强化阿托伐他汀治疗可能预防对比剂肾病,机制可能与抑制炎症反应有关,值得术前推广。更多还原

【Abstract】 Objective To compare the efficacy of high and low dose atorvastatin on preventing contrast induced nephropathy(CIN) in patients underwent coronary angiography.Methods From August 2010 to February 2011,60 patients underwent coronary angiography were randomized to the intensive therapy group(A group) and low dose group(B group).All patients received atorvastatin 10 mg/day on the basis of hydrated therapy(0.9% NaCl solution 1 ml /(kg·h) intravenous hydration 12 h,and encourage patients to drink more water),and high dose group received additional atorvastatin 80 mg at 24 to 72hours before procedure.Serum creatinine(Scr),endogenous creatinine clearance rate(Ccr),serum β2-microglobulin,cystatin c,Hs-CRP before and after the procedure were compared between the two groups.The amount of contrast agent in patients and incidence of adverse reactions were recorded.Results Baseline demographic characteristics and nephropathy risk factors were similar between the two groups.After day 1 and day 3,two groups of serum creatinine(Scr),serum β2-microglobulin(β2-M),cystatin c,Hs-CRP significantly increased when compared with those of preoperation(P<0.05),and those in A group were lower than those in B group(P<0.05).3 days after surgery,serum creatinine(Scr),serum β2-microglobulin(β2-M),cystatin c,Hs-CRP in two groups,significantly increased when compared the postoperative day 1,the difference was statistically significance(P<0.05).Postoperative day 7,serum creatinine(Scr),endogenous creatinine clearance rate(Ccr),serum β2-microglobulin(β2-M),cystatin c,HS-CRP in two groups had no significant difference when compared with those of preoperation.Conclusion High dose atorvastatin use before angiography is superior to low dose atorvastatin on attenuating contrast induced renal dysfunction.High dose atorvastatin use before angiography is worth promoting.更多还原