尹力,李广平,刘彤,袁如玉,郑心田,许纲,刘恩照,徐延敏,车京津,刘相丽,李飞雪,马向红,陈欣,吴雷,樊振旺,阮艳,何梅,李一丁

• 1:天津医科大学第二医院心脏科

摘要(Abstract)：

目的探讨血清半胱氨酸蛋白酶抑制剂C(CyC)在早期诊断对比剂急性肾损害(CIAKI)方面的价值及普罗布考预防急诊PCI术后对比剂急性肾损害的作用。方法本项前瞻性、随机化临床试验共纳入204例因急性冠状动脉综合征接受急诊PCI术的患者(其中普罗布考组96例,对照组108例)。在术前及术后1、2、3天分别取血测定CyC及血清肌酐(Scr)水平。结果以术后CyC增高大于或等于10%作为早期诊断CIAKI的切线值,其敏感性为96.3%,特异性为67.23%;阴性预测值为100%,阳性预测值为30.32%。以Scr为测定值的CIAKI的发生率是13.24%,其中普罗布考组4.17%,对照组21.30%(χ2=11.53,P<0.001)。以CyC为测定值的CIAKI的发生率是41.18%,其中普罗布考组29.16%,对照组51.85%(χ2=10.79,P<0.001)。结论 CyC是早期排除CIAKI的可靠指标。在急诊PCI治疗术的患者,围手术期预防性使用普罗布考能降低CIAKI发生的风险。

关键词(KeyWords)： 造影剂;肾功能不全;急性冠状动脉综合征;普罗布考;血清半胱氨酸蛋白酶抑制剂C;血清肌酐

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 尹力,李广平,刘彤,袁如玉,郑心田,许纲,刘恩照,徐延敏,车京津,刘相丽,李飞雪,马向红,陈欣,吴雷,樊振旺,阮艳,何梅,李一丁

参考文献(References)：

• [1]McCullough PA.Contrast-induced acute kidney injury.J Am Coll Cardiol,2008,51:1419-1428.
• [2]Marenzi G,Lauri G,Assanelli E,et al.Contrast-inducednephropathy in patients undergoing primary angioplasty for acute myocardial infarction.J Am Coll Cardiol,2004,44:1780-1785.
• [3]Patti G,Nusca A,Chello M,et al.Usefulness of statin pretreatment to prevent contrastinduced nephropathy and to improve long-term outcome in patients undergoing percutaneous coronary intervention.Am J Cardiol,2008,101:279-285.
• [4]尹力,李广平,刘红梅.硝苯地平控释片预防对比剂肾损害的随机化临床研究.中国介入心脏病学杂志,2009,17:103-104.
• [5]Yoshida M,Kimura H,Kyuki K,et al.Combined effect of probucol and insulin on renal damage in diabetic rats fed a high cholesterol diet.Eur J Pharmacol,2006,548:174-180.
• [6]Yen HW,Lee HC,Lai WT,et al.Effects of acetylcysteine and probucol on contrast medium-induced depression of intrinsic renal glutathione peroxidase activity in diabetic rats.Arch Med Res,2007,38:291-296.
• [7]Li G,Yin L,Liu T,et al.Role of probucol in preventing contrast-induced acute kidney injury after coronary interventional procedure.Am J cardiol,2009,103:512-514.
• [8]Briguori C,Visconti G,Rivera NV,et al.Cystatin C and contrast-induced acute kidney injury.Circulation,2010,121:2117-2122.
• [9]Kim BJ,Sung KC,Kim BS,et al.Effect of N-Acetylcysteine on cystatin C-based renal function after elective coronary angiography(ENABLE Study):A prospective,randomized trial.Int J Cardiol,2010,138:239-245.
• [10]Bartorelli AL,Marenzi G.Contrast-induced nephropathy.J Interv Cardiol,2008,21:74-85.
• [11]Bellomo R,Kellum JA,Ronco C.Defining acute renal failure:physiological principles.Intensive Care Med,2004,30:33-37.
• [12]Herget-Rosenthal S,Marggraf G,Husing J,et al.Early detection of acute renal failure by serum cystatin C.Kidney Int,2004,66:1115-1122.
• [13]Villa P,Jimenez M,Soriano MC,et al.Serum cystatin C concentration as a marker of acute renal dysfunction in critically ill patients.Crit Care,2005,9:R139-R143.
• [14]Marenzi G,Assanelli E,Marana L,et al.N-Acetylcysteine and contrast-induced nephropathy in primary angioplasty.N Engl J Med,2006,354:2773-2782.
• [15]Miida T,Seino U,Miyazaki O,et al.Probucol markedly reduced HDL phospholipids and elevated prebeta1-HDL without delayed conversion into alpha-migrating HDL:putative role of angiopoietin-like protein3in probucol-induced HDL remodeling.Atherosclerosis,2008,200:329-335.