汪雁博,傅向华,谷新顺,耿巍,王学超,李伟,郝国贞,姜云发,张宏博

• 1:河北医科大学第二医院心内科

摘要(Abstract)：

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。

关键词(KeyWords)： 心肌梗死;血管成形术,经腔,经皮冠状动脉;山莨菪碱;肾病

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 汪雁博,傅向华,谷新顺,耿巍,王学超,李伟,郝国贞,姜云发,张宏博

参考文献(References)：

• [1]Nash K,Hafeez A,Hou S.Hospital-acquired renal insufficiency.Am J Kidney Dis,2002,39:930-936.
• [2]Wickenbrock I,Perings C,Maagh P,et al.Contrast medium induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome:differences in STEMI and NSTEMI.Clin Res Cardiol,2009,98:765-772.
• [3]Lindsay J,Canos DA,Apple S,et al.Causes of acute renal dysfunction after percutaneous coronary intervention and comparison of late mortality rates with postprocedure rise of creatine kinase-MB versus rise of serum creatinine.Am J Cardiol,2004,94:786-789.
• [4]Shoukat S,Gowani SA,Jafferani A,et al.Contrast-induced nephropathy in patients undergoing percutaneous coronary intervention.Cardiol Res Pract,2010,2010:1-12.
• [5]Marenzi G,Assanelli E,Campodonico J,et al.Contrast volume during primary percutaneous coronary intervention and subsequentcontrast-induced nephropathy and mortality.Ann Intern Med,2009,150:170-177.
• [6]Marenzi G,Lauri G,Assanelli E,et al.Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction.J Am Coll Cardiol,2004,44:1780-1785.
• [7]Mautone A,Brown JR.Contrast-induced nephropathy in patients undergoing elective and urgent procedures.J Interv Cardiol,2010,23:78-85.
• [8]Kowalczyk J,Lenarczyk R,Kowalski O,et al.Different types of renal dysfunction in patients with acute myocardial infarction treated with percutaneous coronary intervention.J Interv Cardiol,2007,20:143-152.
• [9]Xiu RJ,Hammerschmidt DE,Coppo PA,et al.Anisodamine inhibits thromboxane synthesis,granulocyte aggregation,and platelet aggregation.A possible mechanism for its efficacy in bacteremic shock.JAMA,1982,247:1458-1460.
• [10]周智广,廖二元,伍汉文,等,糖尿病患者肾血浆流量的变化及山莨菪碱治疗的影响.湖南医科大学学报,1994,19:122-124.
• [11]吴广礼,温进坤,韩梅,等,山莨菪碱对过度训练大鼠急性肾损伤的保护作用.中国微循环,2006,10:241-244.
• [12]Poupko JM,Baskin SI,Moore E.The Pharmacological Properties of Anisodamine.J Appl Toxicol,2007,27:116-121.
• [13]Levey AS,Coresh J,Greene T,et al.Chronic Kidney Disease Epidemiology Collaboration.Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate.Ann Intern Med,2006,145:247-254.
• [14]Mehran R,Nikolsky E.Contrast-induced nephropathy:definition,epidemiology,and patients at risk.Kidney Int Suppl,2006,100:S11-S15.
• [15]Fosbl EL,Thune JJ,Kelbaek H,et al.Long-term outcome of primary angioplasty compared with fibrinolysis across age groups:a Danish Multicenter Randomized Study on Fibrinolytic Therapy Versus Acute Coronary Angioplasty in Acute Myocardial Infarction(DANAMI-2)substudy.Am Heart J,2008,156:391-396.
• [16]McCullough PA,Adam A,Becker CR,et al.Risk prediction of contrast-induced nephropathy.Am J Cardiol,2006,98(6A):27k-36k.
• [17]Fu XH,Fan WZ,Gu XS,et al.Effect of intracoronary administration of anisodamine on slow reflow phenomenon following primary percutaneous coronary intervention in patients with acute myocardial infarction.Chin Med J(Engl),2007,120:1226-1231.
• [18]程世平,刘加林,李丹.丹参、山莨菪碱合剂治疗慢性肾小球肾炎68例疗效观察.临床荟萃,2000,15:895-896.
• [19]Herget-Rosenthal S,Pietruck F,Volbracht L,et al.Serum cystatinC-a superior Marker of rapidly reduced golmerular filtration after unine phrectomy in kidney donors compared to creatinine.Clin Nephrol,2005,64:41-46.
• [20]Zou AP,Parekh N,Steinhausen M.Effect of anisodamine on the microcirculation of the hydronephrotic kidney of rats.Int J Microcirc Clin Exp,1990,9:285-296.
• [21]Norby FL,Ren J.Anisodamine inhibits cardiac contraction and intracellular Ca2+transients in isolated adult rat ventricular myocytes.Eur J Pharmacol,2002,439:21-25.
• [22]Nakagawa S,Kushiya K,Taneike I,et al.Specific inhibitory action of anisodamine against a staphylococcal superantigenic ttoxin,toxic shock syndrome toxin1(TSST-1),leading to down-regulation of cytokine production and blocking of TSST-1toxicity in mice.Clin Diagn Lab Immunol,2005,12:399-408.