本文選題：對比劑誘導的急性腎損傷 + 前列地爾�。� 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討前列地爾對冠心病患者經(jīng)皮冠狀動脈介入治療(Percutaneous coronary intervention,PCI)術后對比劑誘導的急性腎損傷(contrast induced acute kidney injury,CIAKI)預防作用、并分析可能的作用機制、觀察其用藥安全性。方法:前瞻性連續(xù)入選2015年1月~2016年12月于天津市第一中心醫(yī)院、天津市第四中心醫(yī)院、天津市泰達國際心血管病醫(yī)院、天津市胸科醫(yī)院四個研究中心,擬行PCI術的冠心病患者共700例。入選患者被隨機分為兩組:前列地爾組(n=350)、對照組(n=350)。前列地爾組圍手術期給予水化聯(lián)合前列地爾治療;對照組圍手術期僅給予單純水化治療。通過比較PCI術前和術后72h,兩組患者血尿素氮(Blood urea nitrogen,BUN)、腎小球濾過率(estimated glomerular filtration rate,eGFR)、血清肌酐(Serum creatinine,Scr)、中性粒細胞明膠酶相關脂質(zhì)運載蛋白(Neutrophil gelatinase-associated lipid transport protein,NGAL)水平變化。探討前列地爾對CIAKI是否具有預防作用,并通過比較兩組患者PCI術前、術后72h的腫瘤壞死因子α(tumor necrosis factor,TNF-α)、超氧化物歧化酶(Superoxide dismutase,SOD)、還原型谷胱甘肽(glutathione,GSH)、白細胞介素-6(Interleukin-6,IL-6)等炎癥及氧化應激因子的變化,探討前列地爾腎臟保護機制,同時記錄前列地爾組有無低血壓、心臟及腎臟不良事件發(fā)生。結果:1.兩組患者基線資料基本一致(P0.05)。2.PCI術前,兩組患者的血液中eGFR、BUN、Scr、TNF-α、IL-6、SOD、NGAL及GSH水平,差異無統(tǒng)計學意義(P0.05)。3.前列地爾組共有8例患者發(fā)生CIAKI,發(fā)病率為2.3%;對照組共有28例患者發(fā)生CIAKI,發(fā)病率為8%,兩組CIAKI發(fā)病率(2.3%vs 8%),差異有統(tǒng)計學意義(P0.05)。4.PCI術后72h,兩組患者的血液中反映腎功能的BUN、Scr、eGFR水平與術前相比無明顯變化,差異無統(tǒng)計學意義(P0.05)。5.與術前相比,PCI術后72h兩組患者血液中NGAL、IL-6、SOD、TNF-α及GSH水平明顯增高,差異有統(tǒng)計學意義(P0.05)。6.PCI術后72h,前列地爾組患者的血液中NGAL、IL-6及GSH水平較對照組明顯降低,差異有統(tǒng)計學意義(P0.05)。7.前列地爾治療組患者住院期間用藥安全性良好。結論:1.圍手術期前給予患者前列地爾治療,能明顯降低冠心病患者PCI術后CIAKI的發(fā)病率。2.前列地爾具有保護腎功能的作用。其機制可能與其抗炎癥、抗氧化及擴張腎血管作用有關。3.前列地爾具有良好的安全性。
[Abstract]:Objective: to investigate the preventive effect of alprostadil on acute renal injury induced by (contrast induced acute kidney injuryn CIAKI after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Methods: prospective candidates were selected from January 2015 to December 2016 at Tianjin first Central Hospital, Tianjin fourth Central Hospital, Tianjin Taida International Cardiovascular Disease Hospital, Tianjin chest Hospital, and four research centers. There were 700 patients with coronary heart disease undergoing PCI. The patients were randomly divided into two groups: alprostadil group (n = 350) and control group (n = 350). The patients in the alprostadil group were treated with hydration combined with alprostadil during perioperative period, while the control group were only treated with pure hydration during the perioperative period. The changes of blood urea nitrogen (urea), glomerular filtration rate (estimated glomerular filtration), serum creatinine SCR (creatinine SCR) and neutrophil gelatinase-associated lipid transport protein (Neutrophil gelatinase-associated lipid transport) were compared between the two groups before and 72 hours after PCI. To investigate the preventive effect of alprostadil on CIAKI, and compare the two groups of patients before PCI. TNF- 偽, superoxide dismutase (SOD), glutathione (GSH), interleukin-6 (IL-6) and other inflammatory and oxidative stress factors were observed 72 hours after operation. At the same time, the adverse events of heart and kidney and hypotension were recorded in alprostadil group. The result is 1: 1. The baseline data of the two groups were basically the same (P0.05). 2. Before PCI, there was no significant difference (P0.05) between the two groups in the levels of eGFR- BUN-Scr-TNF- 偽 IL-6, SODNGAL and GSH (P0.05). There were 8 patients with CIAKI in the alprostadil group and 28 patients with CIAKI in the control group. The incidence of CIAKI was 8% in the control group. The difference was statistically significant (P0.05). 4. The renal function was reflected in the blood of the two groups at 72 hours after PCI. There was no significant change in the level of BUNA Scr-eGFR compared with that before operation. The difference was not statistically significant (P0.05). Compared with the patients before PCI 72 hours after PCI, the blood levels of NGALL IL-6 / SODN- 偽 and GSH in the two groups were significantly higher than those in the control group (P0.05). 6. The levels of NGALL IL-6 and GSH in the blood of the patients in the proprostadil group were significantly lower than those in the control group (P0.05) at 72 hours after PCI (P0.05). The safety of alprostadil treatment group was good during hospitalization. Conclusion 1. The incidence of CIAKI in patients with coronary heart disease after PCI was significantly decreased by the treatment of alprostadil before the perioperative period. Alprostadil can protect kidney function. Its mechanism may be related to its anti-inflammatory, anti-oxidation and dilatation of renal vessels. Prostadil has good safety.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692.5;R541.4

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