他汀与造影剂肾病精编版课件.ppt

尽量选用肾脏代谢少的他汀 上市剂量 半衰期 蛋白结合率 代谢途径 阿托伐他汀 10-80 mg 14 小时 98% 几乎全部经过胆汁 瑞舒伐他汀 5-20mg 19小时 88％ 72％经过胆汁 28％经过肾脏 （静脉注射） 辛伐他汀 10-40 mg 约2小时 94% 60% 经过胆汁 普伐他汀 10-40 mg 约2-3小时 50% 70%经过胆汁, 20%经过肾脏 氟伐他汀 10-80 mg 约2小时 98% 93%经过胆汁 6% 经过肾脏 洛伐他汀 20-80 mg 约1-2小时 98% 83%经过胆汁 10%经过肾脏 各产品说明书 对于肾功能不全的患者，尽量选择不需要调整剂量的他汀 eGFR（ mL/min/1.73 m2 ）降低调整 69-90 15-59 15 阿托伐他汀 不 不 不 瑞舒伐他汀 需要 需要 需要 辛伐他汀 ？ ？ ？ 普伐他汀 不 不 不 氟伐他汀 不 ？ ？ 洛伐他汀 不 ↓50％ ↓50％ K/DOQI Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease . Am J Kidney Dis 2003; 41 (suppl 3): S1-S91 总结：他汀预防CIN，一箭双雕 与其他使用造影剂的诊断和治疗手段相比，接受PCI手术的患者更容易发生CIN CIN是PCI术后预后的重要预测指标 多项研究证实，术前他汀治疗能显著降低CIN发生率，改善PCI预后，同时改善肾功能 接受PCI手术的患者，术前常规使用他汀以预防CIN 讨论2 对于肾功能不全的患者，下列哪种他汀不需调整剂量？ A. 阿托伐他汀 B. 瑞舒伐他汀 C. 辛伐他汀 D. 佛伐他汀 讨论3 PCI术前应用他汀，一箭双雕的含义？ A. PCI术前应用他汀，不仅可减少围手术期心梗，还可以预防CIN B. PCI术前应用他汀，不仅可预防CIN,还可以减少造影剂的用量 * There is a strong bidirectional association between cardiac diseases and renal insufficiency. * In patients with chronic renal insuf?ciency, further decline in renal function (DRF) after percutaneous coronary intervention (PCI) is accompanied not only by adverse in-hospital events but also by increased risk of mortality and myocardial infarction at 1 year. This analysis was undertaken to determine if patients with normal renal function who develop DRF after PCI have a comparable increase in risk of death and myocardial infarction at 1 year, and whether this risk is independent of in-hospital complications (death, myocardial infarction, urgent coronary artery bypass grafting). We performed a retrospective analysis of all patients from a single center who underwent successful PCI with no major in-hospital complications who had pre-PCI serum creatinine (SCr) ≤ 1.2 mg/dl and no history of renal insuf?ciency. One-year follow-up was obtained by mail or telephone. There were 5,967 consecutive patients who met the inclusion criteria. Of these, 208(3.5%) developed DRF (an increase in SCr ≥ 50% of baseline). They were more l