黄晶,袁敏杰,马士新,杭靖宇,魏钧伯,赵钢,李京波,魏盟,陆志刚

• 1:上海交通大学附属第六人民医院心内科

摘要(Abstract)：

目的评价丹参多酚酸盐对急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后对比剂肾病(contrast-induced nephropathy,CIN)的保护作用,分析急诊PCI术后发生CIN的危险因素。方法连续入选2014年12月至2016年7月上海交通大学附属第六人民医院因急性心肌梗死接受急诊PCI术的患者,随机分入丹参多酚组和单纯水化组,比较两组患者术后CIN的发生率以及血肌酸酐(serum creatinine,Scr)、估算的肾小球滤过率(estimated glomerular filtration rate,e GFR)和胱抑素C的变化情况,并比较两组不良事件的发生情况。通过多因素logistic回归,分析急诊PCI术后发生CIN[以Scr水平绝对升高≥0.5 mg/dl(44.2μmol/L)为诊断标准]的危险因素。结果共入选314例患者,最终306例(丹参多酚组152例,单纯水化组154例)纳入统计。丹参多酚组与单纯水化组相比,急诊PCI术后CIN的发生率(13.2%比26.6%,P=0.003)和CIN的发生风险(OR 0.340,95%CI 0.170~0.678,P=0.002)降低,术后Scr绝对升高值[(28.99±22.59)μmol/L比(36.79±35.26)μmol/L,P=0.022]和相对升高幅度[(39.15±29.07)%比(51.00±41.84)%,P=0.009]较低,术后e GFR绝对降低值[(29.03±20.11)ml/(min·1.73 m2)比(34.29±19.82)ml/(min·1.73 m2),P=0.004]和相对降低幅度[(28.46±15.11)%比(33.22±17.08)%,P=0.010]较小。丹参多酚组术后1个月内的联合不良终点事件发生率低于单纯水化组(13.8%比26.6%,P=0.005)。多因素logistic回归分析显示,较高肌酸激酶(creatine kinase,CK)峰值水平(OR 1.245,95%CI1.064~1.457,P=0.006)和氨基末端B型脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-pro BNP)峰值水平(OR 1.158,95%CI 1.011~1.327,P=0.034)是发生CIN的独立危险因素。结论丹参多酚酸盐对急诊PCI术后CIN的发生有一定的保护作用,并可降低近期不良事件的发生率。较高的CK和NT-pro BNP峰值水平是急诊PCI术后发生CIN的独立危险因素。

关键词(KeyWords)： 急性心肌梗死;经皮冠状动脉介入治疗;对比剂肾病;丹参多酚酸盐

Abstract:

Keywords:

基金项目(Foundation): 上海市卫生和计划生育委员会中医药科研基金项目(2014LP027A)

作者(Author): 黄晶,袁敏杰,马士新,杭靖宇,魏钧伯,赵钢,李京波,魏盟,陆志刚

参考文献(References)：

• [1]Nash K,Hafeez A,Hou S.Hospital-acquired renal insufficiency.Am J Kidney Dis,2002,39(5):930-936.
• [2]Chalikias G,Drosos I,Tziakas DN.Contrast-Induced Acute Kidney Injury:An Update.Cardiovasc Drugs Ther,2016,30(2):215-228.
• [3]Golshahi J,Nasri H,Gharipour M.Contrast-induced nephropathy:A literature review.J Nephropathol,2014,3(2):51-56.
• [4]Santos PR,Carneiro Neto JD,Arcanjo FP,et al.Contrastinduced nephropathy after primary angioplasty for acute myocardial infarction.J Bras Nefrol,2015,37(4):439-445.
• [5]Abe D,Sato A,Hoshi T,et al.Clinical predictors of contrastinduced acute kidney injury in patients undergoing emergency versus elective percutaneous coronary intervention.Circ J,2014,78(1):85-91.
• [6]Mc Cullough PA,Adam A,Becker CR,et al.Epidemiology and Prognostic Implications of Contrast-Induced Nephropathy.Am J Cardiol,2006,98(6A):5K-13K.
• [7]Blackman DJ,Pinto R,Ross JR.Impact of renal insufficiency on outcome after contemporary percutaneous coronary intervention.Am Heart J,2006,151(1):146-152.
• [8]Jurado-Román A,Hernández-Hernández F,García-Tejada J,et al.Role of hydration in contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention.Am J Cardiol,2015,115(9):1174-1178.
• [9]O'Gara PT,Kushner FG,Ascheim DD,et al.2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction.J Am Coll Cardiol,2013,61(4):e78-140.
• [10]Luo Y,Wang X,Ye Z,et al.Remedial hydration reduces the incidence of contrast-induced nephropathy and short-term adverse events in patients with ST-segment elevation myocardial infarction:a single-center,randomized trial.Intern Med,2014,53(20):2265-2272.
• [11]Li X,Yu C,Sun W,et al.Simultaneous determination of magnesium lithospermate B,rosmarinic acid,and lithospermic acid in beagle dog serum by liquid chromatography/tandem mass spectrometry.Rapid Commun Mass Spectrom,2004,18(23):2878-2882.
• [12]Fei AH,Cao Q,Chen SY,et al.Salvianolate inhibits reactive oxygen species production in H2O2-treated mouse cardiomyocytes in vitro via the TGFβpathway.Acta Pharmacol Sin,2013,34(4):496-500.
• [13]Meng C,Zhuo XQ,Xu GH,et al.Protection of Salvianolate against Atherosclerosis via Regulating the Inflammation in Rats.J Huazhong Univ Sci Technolog Med Sci,2014,34(5):646-651.
• [14]Fu P,Huang XQ,Yuan AH,et al.Effects of salvianolate combined with alprostadil and reduced glutathione on progression of chronic renal failure in patients with chronic kidney diseases:a long-term randomized controlled trial.Zhong Xi Yi Jie He Xue Bao,2012,10(6):641-646.
• [15]Thomsen HS,Morcos SK.Contrast media and the kidney:European Society of Urogenital Radiology(ESUR)guidelines.Br J Radiol,2003,76(908):513-518.
• [16]Bellomo R,Ronco C,Kellum JA,et al.Acute renal failuredefinition,outcome measures,animal models,fluid therapy and information technology needs:the Second International Consensus Conference of the Acute Dialysis Quality Initiative(ADQI)Group.Crit Care,2004,8(4):R204-212.
• [17]Mehran R,Aymong ED,Nikolsky E,et al.A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention.J Am Coll Cardiol,2004,44(7),1393-1399.
• [18]Marenzi G,Lauri G,Assanelli E,et al.Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction.J Am Coll Cardiol,2004,44(9):1780-1785.
• [19]Park SH,Jeong MH,Park IH,et al.Effects of combination therapy of statin and N-acetylcysteine for the prevention of contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.Int J Cardiol,2016,212:100-106.
• [20]Abouzeid S,Mosbah O.Evaluation of different sodium bicarbonate regimens for the prevention of contrast mediuminduced nephropathy.Electron Physician,2016,8(2):1973-1977.
• [21]Xu M,Wang YP,Luo WB,et al.Salvianolate inhibits proliferation and endothelin release in cultured rat mesangial cells.Acta Pharmacol Sin,2001,22(7):629-633.
• [22]Han B,Zhang X,Zhang Q,et al.Protective effects of salvianolate on microvascular flow in a porcine model of myocardial ischaemia and reperfusion.Arch Cardiovasc Dis,2011,104(5):313-324.