本文選題：阿托伐他汀 + 普羅布考　； 參考：《中華高血壓雜志》2017年07期

【摘要】：目的探討阿托伐他汀聯(lián)合普羅布考治療對(duì)經(jīng)皮冠狀動(dòng)脈介入治療(PCI)術(shù)后造影劑腎病(CIN)的預(yù)防作用、安全性及可能機(jī)制。方法入選2013年2月至2015年6月于天津市胸科醫(yī)院心內(nèi)科行擇期PCI術(shù)的冠狀動(dòng)脈性心臟病(冠心病)患者共330例,按隨機(jī)數(shù)字表法隨機(jī)分為3組:常規(guī)劑量阿托伐他汀組(A組,n=110)、強(qiáng)化劑量阿托伐他汀組(B組,n=110)、常規(guī)劑量阿托伐他汀聯(lián)合普羅布考組(C組,n=110)。A組:術(shù)前1d開(kāi)始給予阿托伐他汀20mg,1次/晚;B組:術(shù)前1d開(kāi)始給予阿托伐他汀40mg,1次/晚;C組:術(shù)前1d開(kāi)始給予阿托伐他汀20mg,1次/晚和普羅布考250mg,3次/d。3組患者均于PCI術(shù)后4d開(kāi)始僅給予阿托伐他汀20mg,1次/晚。收集3組患者的基本資料、造影劑用量,并記錄PCI術(shù)前及術(shù)后72h的血清肌酐、血尿素氮、估算的腎小球?yàn)V過(guò)率(eGFR)、高敏C反應(yīng)蛋白(hsCRP)、丙二醛、丙氨酸氨基轉(zhuǎn)移酶(ALT)水平的變化。記錄3組患者CIN發(fā)生情況、住院期間阿托伐他汀及普羅布考的不良反應(yīng)。結(jié)果 3組患者術(shù)前基線資料差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。B組和C組CIN發(fā)生率低于A組(1.8%,2.7%比10.0%,均P0.05);B組與C組CIN發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。PCI術(shù)后72h,A組患者的肌酐、尿素氮水平較術(shù)前升高,eGFR水平較術(shù)前下降(均P0.05);B組、C組患者的肌酐、尿素氮水平低于A組[(80.99±16.65),(81.79±17.96)比(93.30±20.97)μmol/L;(5.78±0.92),(6.05±1.29)比(6.18±1.08)mmol/L],eGFR水平高于A組[(78.80±26.04),(75.42±20.81)比(69.39±22.81)mL/(min·1.73m~2),均P0.05]。PCI術(shù)后,3組患者的hsCRP、丙二醛水平較術(shù)前升高(均P0.05);B組和C組患者的hsCRP、丙二醛水平低于A組。多因素Logistic回歸分析顯示強(qiáng)化他汀(OR=0.093,95%CI0.016~0.533,P=0.008)及他汀聯(lián)合普羅布考(OR=0.252,95%CI 0.068~0.931,P=0.039)是CIN的保護(hù)因素;住院期間,3組患者均未出現(xiàn)明顯肝損害、肌無(wú)力等不良事件。結(jié)論強(qiáng)化劑量阿托伐他汀及常規(guī)劑量阿托伐他汀聯(lián)合普羅布考均能降低CIN的發(fā)生率,并且有良好的安全性,其機(jī)制可能與抑制炎癥、氧化應(yīng)激反應(yīng)有關(guān)。
[Abstract]:Objective to investigate the preventive effect, safety and possible mechanism of Atto vastatin combined with probucol on contrast-agent nephropathy after percutaneous coronary intervention (PCI). Methods from February 2013 to June 2015, a total of 330 patients with coronary heart disease (CHD) underwent elective PCI operation in Department of Cardiology, Tianjin chest Hospital. According to the random digital table method, three groups were randomly divided into three groups: routine dose of Atto vastatin group (group A), group A (group A), intensive dose of Atto vastatin group (group B), group B (group B), routine dose of Atto vastatin combined with probucol group (group C) and group C (group A): Atto was given 1 day before operation. The patients in group B received 40 mg of Atto at 1 day before operation: 20 mg of Atto statin once per night on the first day of operation and only once a time of 20 mg / d of probucol 250 mg of probucol on the 4th day after PCI. The patients in group B received only 20 mg / d of Atto vastatin at the beginning of 4 days after PCI. The patients in group B received only 20 mg / d of Atto vastatin at the beginning of the first day of operation and only 20 mg / d of probucol at the beginning of 4 days after PCI. The changes of serum creatinine, blood urea nitrogen, estimated glomerular filtration rate (GFR), Gao Min C-reactive protein hsCRP, malondialdehyde (MDA) and alanine aminotransferase (alt) were recorded before and 72 hours after PCI. The incidence of CIN and the adverse reactions of Atto vastatin and probucol during hospitalization were recorded. Results there was no significant difference in preoperative baseline data among the three groups. The incidence of CIN in group B and group C was lower than that in group A (1.8% vs 10.0%). There was no significant difference in the incidence of CIN between group B and group C. The level of urea nitrogen was higher than that before operation and the level of eGFR was lower than that before operation (P 0.05). 灝跨礌姘按騫充綆浜嶢緇刐(80.99鹵16.65),(81.79鹵17.96)姣，

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