普罗布考对冠状动脉粥样硬化性心脏病患者冠状动脉介入治疗后对比剂肾病影响.docxVIP

普罗布考对冠状动脉粥样硬化性心脏病患者冠状动脉介入治疗后对比剂肾病的影响 天津市胸科医院 心内科 董军、刘寅、孙跟义 摘要 目的：观察普罗布考对冠状动脉粥样硬化性心脏病(冠心病)患者行冠状动脉介入治疗后肾功能的影响。方法：连续入选121例冠心病合并高血压并接受冠状动脉介入治疗的患者。按照完全随机化原则分为使用普罗布考组和对照组(未用普罗布考)。普罗布考组在冠状动脉造影前2 天应用普罗布考375mg，2次/天，术后继续使用3天。记录患者的基本资料及术后72h血清肌酐并用MDRD方法计算其术前、术后估计肾小球滤过率(eGFR)。分析介入治疗后CIN的发生率，两组冠状动脉介入术前后eGFR、血清肌酐的变化。结果：普罗布考组手术前后eGFR、血清肌酐未有显著性差异。而对照组术后eGFR 较术前明显降低(P＜0.05)，术后血清肌酐较术前明显增加(P＜0.05) 。术后72 h血清肌酐与基线血清肌酐的差值(ΔScr)对照组明显升高(P＜0.05)，ΔeGFR明显降低(P＜0.05)。普罗布考组CIN发生率较对照组有下降趋势(3.08%比8.93%，P＞0.05)。结论：对冠心病患者行冠状动脉介入治疗，术前应用普罗布考可能有保护肾功能，预防对比剂肾病的作用。 关键词 对比剂肾病 普罗布考 介入治疗 Prevention Role of Probucol on Contrast-induced Nephropathy after Coronary Angioplasty Tian jin Chest Hospital Dong Jun Liu Yin Sun Gen yi Abstract Objective: To study the role of probucol on CIN in patients of coronary atherosclerotic heart disease(CHD) undergoing coronary angioplasty.Methods: One hundred twenty one hospitalized patients of CHD with hypertension undergoing coronary angioplasty were enrolled to the study.Patients were randomly divided to probucol group(n=65) or control group(n=56). In the probucol group, the patients received probucol tablets 375mg bid for 2 days before procedure and continued to use probucol 3 days after procedure. The baseline clinical, biochemical, and procedural characteristics were collected prospectively before the angioplasty, and follow-up serum creatinine were measured 72 h after angioplasty. Baseline and follow-up glomerular filtration rate(eGFR) were estimated using the Modified Diet in Renal Disease study(MDRD) formula. We analyzed and compared the incidence of CIN after angioplasty, the change of serum creatinine, and eGFR between the two groups. Results: There were no significant differences at baseline in majority measured parameters between two groups. Serum creatinine, eGFR after angioplasty were unchanging compared to pre-procedure in the probucol group. eGFR level decreased from (83.1±19.8) to (76.2±17.9)mL/min in control group (P＜0.05), Scr level incr