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目的观察阿托伐他汀对冠状动脉介入诊断及治疗的患者肾功能、尿微量蛋白改变的影响。方法 246例冠状动脉介入诊断与治疗的患者随机分为他汀组和对照组,每组123例。他汀组于冠状动脉造影术前3 d开始每晚顿服阿托伐他汀40 mg,对照组未服用阿托伐他汀及其他调脂类药。所有患者采用水化治疗。观察患者术前1 d、术后36～48 h血清肌酐(Scr)、超敏C反应蛋白(hsCRP)、内生肌酐清除率(Ccr)、尿α1微球蛋白(α1-MG)/尿肌酐(Ucr)、尿微量白蛋白(mALB)/尿肌酐(Ucr)的改变情况。结果两组患者术后血hsCRP、Scr,尿αl-MG/Ucr及mALB/Ucr较术前均升高(均P<0.05),而血Ccr较术前降低(P<0.05)。对照组术后血hsCRP、尿αl-MG/Ucr较他汀组术后明显升高(P<0.05),对照组造影剂肾病发生率(8.13%)高于他汀组(0.81%,P<0.05)。结论造影剂可造成轻微的肾功能损害;术前3 d使用大剂量阿托伐他汀,可能具有减轻炎症反应、预防造影剂肾病发生的作用。
Objective To observe the effect of atorvastatin on renal function and urine microalbuminuria in patients with coronary artery disease. Methods 246 cases of coronary intervention and treatment of patients were randomly divided into statin group and control group, 123 cases in each group. Atorvastatin 40 mg was administered to the statin group on night before coronary angiography at 3 days. Atorvastatin and other lipid-lowering drugs were not given in the control group. All patients treated with hydration. The levels of serum creatinine (Scr), hsCRP, Ccr, urinary α1-microglobulin (α1-MG) / urinary creatinine (Ucr), urinary microalbumin (mALB) / urinary creatinine (Ucr) changes. Results The postoperative blood levels of hsCRP, Scr, urinary α1-MG / Ucr and mALB / Ucr in the two groups were significantly higher than those before the operation (all P <0.05), while the blood Ccr was lower than that before the operation (P <0.05). The postoperative hsCRP and urinary α1-MG / Ucr in the control group were significantly higher than those in the statin group (P <0.05). The incidence of contrast agent nephropathy in the control group (8.13%) was significantly higher than that in the statin group (0.81%, P <0.05) . Conclusions Contrast medium can cause slight damage of renal function. At high dose of atorvastatin 3 d before operation, it may have the effect of reducing the inflammatory reaction and preventing the occurrence of contrast agent nephropathy.