静脉用尼可地尔对急性冠脉综合征合并糖尿病患者经皮冠状动脉介入治疗术后肾功能的影响

doi:10.3969/j.issn.1674-490X.2019.03.004

摘要/Abstract

摘要： 目的探讨静脉应用尼可地尔对急性冠脉综合征合并糖尿病患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后肾功能的保护作用及可能的机制。方法择期行PCI治疗的急性冠脉综合征合并糖尿病患者随机分为对照组(静脉水化治疗)和观察组(静脉水化治疗+PCI术前5 h至术后24 h静脉应用尼可地尔0.1 mg/kg·h)。所有患者分别于术前24 h及术后6 h、24 h、48 h、72 h抽血检测肾功能、炎症及心功能相关指标,主要终点为对比剂肾病(contrast-induced nephropathy,CIN)的发生率。结果共入选85例患者,随机分为对照组(43例)和观察组(42例)。(1)观察组与对照组相比,CIN发生率(4.76% vs 11.63%)低,但差异无统计学意义(P＞0.05)。(2)观察组术后48 h及72 h SCr、β₂-MG、CysC水平低于对照组,差异有统计学意义(P＜0.05)。观察组PCI术后48 h及72 h eGFR明显高于对照组,差异有统计学意义(P＜0.05)。(3)观察组hs-CRP、SAA、NLR、NT-ProBNP水平在术后24 h明显低于对照组,差异有统计学意义(P＜0.05)。结论静脉应用尼可地尔没有明显降低急性冠脉综合征合并糖尿病患者PCI术后CIN的发生率,但对患者的肾功能及心功能有保护作用,可能的机制为抑制机体炎症反应,增加肾脏灌注。

关键词: 对比剂肾病, 血清肌酐, 胱抑素C, 尼可地尔, 急性冠脉综合征, 糖尿病, 经皮冠状动脉介入治疗

Abstract: Objective To investigate whether intravenous administration nicorandil can protect renal function in ACS patients with type 2 diabetes mellitus after PCI and the possible mechanism. Methods The ACS patients with DM who were selected for PCI were randomly divided into the control group(intravenous hydration treatment)and the observation group(intravenous hydration treatment + intravenous administration nicorandil treatment 0.1 mg/kg·h from 5 h before PCI to 24 h after PCI). All patients underwent blood sampling at 24 h before PCI and 6 h, 24 h, 48 h and 72 h after PCI to detect indicators related to renal function, inflammation and cardiac function. The main endpoint was the incidence of CIN. Results The levels of SCr, β₂-MG and CysC in the observation group at 48 h and 72 h after PCI were lower than those in the control group, the difference was statisticallysignificant(P＜0.05). The eGFR in the observation group at 48 h and 72 h after PCI was significantly higher than that in the control group, and the difference was statistically significant(P＜0.05). The level of hs-CRP, SAA, NLR and NT-ProBNP in the observation group were significantly lower than those in the control group at 24 h after PCI, there was significant difference between two groups(P＜0.05). Conclusion Intravenous administration nicorandil can not reduce the incidence of CIN, but can protect renal function and cardiac function in ACS patients with DM after PCI. The possible mechanism is to inhibit the inflammatory response and increase renal perfusion.

Key words: contrast-induced nephropathy, serum creatinine, cystatin C, nicorandil, acute coronary syndrome, diabetes mellitus, percutaneous coronary intervention

中图分类号:

贺玉晓,陈春红,贾辛未,王占启,王艳飞. 静脉用尼可地尔对急性冠脉综合征合并糖尿病患者经皮冠状动脉介入治疗术后肾功能的影响[J]. 医学研究与教育, 2019, 36(3): 19-26.

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