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目的评价山莨菪碱对ST-段抬高心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)的预防作用。方法入选2010年3月至2011年12月首诊于我院的发病12小时内的STEMI连续病例。将入选患者按随机数字表法分为山莨菪碱组(ANI)和对照组(CON)。采集患者入院时及PCI后24、48、72小时肘静脉血检测血肌酐(SCr)和胱抑素C(CysC)水平。计算估测的肾小球滤过率(estimated glomerular filtrationrate,eGFR)。结果累计入选2010年3月至2011年12月发病12小时内的STEMI连续病例177例,其中ANI组88例,CON组89例。ANI组患者CIN发生率(18/88)明显低于CON组(30/89)。ANI组患者PCI术后肾功能优于CON组。多因素回归分析结果显示,糖尿病病史和心功能不全是CIN发生的危险因素,而应用山莨菪碱进行预防是CIN发生的独立保护因素(OR=0.369,95%CI0.171～0.794,P=0.011)所有患者均未发生严重不良反应。结论直接PCI术前和术后应用山莨菪碱可以有效降低STEMI患者CIN发生率,且无明显不良反应。
Objective To evaluate the preventive effect of anisodamine on contrast nephropathy (CIN) after direct percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods Selected from March 2010 to December 2011 first diagnosed in our hospital within 12 hours of onset STEMI continuous cases. The selected patients were divided into anisodamine group (ANI) and control group (CON) by random number table. The levels of serum creatinine (SCr) and cystatin C (CysC) in elbow venous blood were measured at 24, 48 and 72 hours after admission and at PCI. Estimated glomerular filtration rate (eGFR) was calculated. Results A total of 177 STEMI cases were included within 12 hours from March 2010 to December 2011, of which 88 were in the ANI group and 89 in the CON group. The incidence of CIN in ANI group (18/88) was significantly lower than that in CON group (30/89). The ANI group had better renal function after PCI than CON group. Multivariate regression analysis showed that the history of diabetes mellitus and cardiac dysfunction were risk factors for CIN, and the prevention of anisodamine was an independent protective factor of CIN (OR = 0.369, 95% CI0.171-0.794, P = 0.011 No serious adverse reactions occurred in all patients. Conclusions The application of anisodamine before and after PCI can effectively reduce the incidence of CIN in STEMI patients with no obvious adverse reactions.