【摘要】 目的探讨尼可地尔对老年冠心病患者PCI术后造影剂肾病(contrast-induced nephropathy,CIN)的预防作用。方法连续入选2018年1～12月天津市胸科医院心内三科择期行PCI的老年冠心病患者300例,随机分为对照组150例,尼可地尔组150例。主要研究终点是CIN发生率,定义为造影剂给药后72h内血肌酐水平较原有基础升高25%或者绝对值升高≥44.2μmol/L。次要终点是血尿素、肌酐、胱抑素C、肌酐清除率48及72h的变化,住院期间及术后14d随访主要不良事件发生情况。结果尼可地尔组CIN发生率明显低于对照组,差异有统计学意义(3.3%vs 10.7%,P=0.002)。尼可地尔组术后48及72h血尿素、肌酐、胱抑素C水平较对照组明显降低,肌酐清除率较对照组明显升高,差异有统计学意义(P<0.05,P<0.01)。2组住院期间和术后14d随访主要不良事件发生率比较,差异无统计学意义(3.3%vs 4.0%,P>0.05)。logistic回归分析显示,尼可地尔是CIN的独立保护因子(OR=0.180,95%CI:0.041～0.788,P=0.023)。结论冠心病患者预防性给予尼可地尔可降低PCI术后的CIN发生率。更多还原

【Abstract】 Objective To study the role of nicorandil in preventing contrast-induced nephropathy(CIN)in elderly chronic heart disease(CHD)patients undergoing PCI.Methods Three hundred elderly CHD patients admitted to our hospital from January 2018 to December 2018 for PCI were randomly divided into control group(n=150)and nicorandil treatment group(n=150).The incidence of CIN,which was defined as an increase of 25%in serum Scr or as an absolute value of≥44.2μmol/L,was recorded within 72 hafter exposure to contrast medium.The serum urea,Scr,Cys-C levels and the Ccr were measured,and the major adverse events were recorded during the hospital stay time and the 14-day follow-up period.Results The incidence of CIN was significantly lower in nicorandil treatment group than in control group(3.3%vs 10.7%,P=0.002).The serum urea,Scr,Cys-C levels were significantly lower while the Ccr was significantly higher in nicorandil treatment group than in control group at 48 hand 72 hafter PCI(P<0.05,P<0.01).No significant difference was detected in the incidence of major adverse events during the hospital stay time and the 14-day follow-up period between the two groups(3.3 vs 4.0%,P>0.05).Logistic regression analysis showed that nicorandil was an independent protective factor for CIN(OR=0.180,95%CI:0.041-0.788,P=0.023).Conclusion Nicorandil can reduce the incidence of CIN in elderly CHD patients undergoing PCI.更多还原