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  • 窦鸿伟,王国位,陈亮,李攀,阚通,秦永文.冠状动脉造影术前应用瑞舒伐他汀和阿托伐他汀对老年患者肾功能影响的对比分析[J].第二军医大学学报,2018,39(12):1330-1335    [点击复制]
  • DOU Hong-wei,WANG Guo-wei,CHEN Liang,LI Pan,KAN Tong,QIN Yong-wen.Effects of rosuvastatin and atorvastatin before coronary angiography on postoperative renal function in elderly patients: a comparative analysis[J].Acad J Sec Mil Med Univ,2018,39(12):1330-1335   [点击复制]
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冠状动脉造影术前应用瑞舒伐他汀和阿托伐他汀对老年患者肾功能影响的对比分析
窦鸿伟1△,王国位1△,陈亮1,2,李攀1,阚通1,秦永文1*
0
(1. 海军军医大学(第二军医大学)长海医院心血管内科, 上海 200433;
2. 解放军联勤保障部队904医院心血管内科, 无锡 214000
共同第一作者
*通信作者)
摘要:
目的 探讨冠状动脉造影术前使用瑞舒伐他汀和阿托伐他汀对老年患者术后肾功能影响。方法 纳入2018年1月至6月在海军军医大学(第二军医大学)长海医院心血管内科行冠状动脉造影术的老年患者345例,按照接受他汀类药物的不同分为瑞舒伐他汀组(171例)和阿托伐他汀组(174例),然后再将两组患者分别分为<70岁和≥ 70岁亚组。所有患者均继续原有常规用药并于每晚睡前服用常规剂量他汀类药物,分别于术前、术后72 h内测定血清肌酐水平,并分析各组患者术后造影剂肾病的发生情况。结果 瑞舒伐他汀组患者冠状动脉造影术后血清肌酐水平为(99.2±28.9)μmol/L,高于术前水平[(92.2±29.5)μmol/L],差异有统计学意义(t=4.734,P<0.01);阿托伐他汀组术前、术后血清肌酐水平差异无统计学意义(P>0.05)。无论<70岁亚组还是≥ 70岁亚组的患者,瑞舒伐他汀组术后血清肌酐水平均较术前升高[(88.0±15.6)μmol/L vs(82.3±13.5)μmol/L,(104.8±32.2)μmol/L vs(97.2±33.7)μmol/L],差异均有统计学意义(t=3.858、3.657,P均<0.01);阿托伐他汀组<70岁亚组的患者术后血清肌酐水平高于术前水平[(128.3±44.4)μmol/L vs(122.4±43.4)μmol/L],差异有统计学意义(t=2.854,P=0.006),而≥ 70岁亚组患者术前、术后血清肌酐水平差异无统计学意义(P>0.05)。瑞舒伐他汀组患者造影剂肾病的发生率高于阿托伐他汀组[21.1%(36/171)vs 6.9%(12/174)],差异有统计学意义(χ2=14.430,P<0.01),并且瑞舒伐他汀组≥ 70岁亚组患者的造影剂肾病发生率高于<70岁亚组的患者[28.9%(33/114)vs 5.3%(3/57)],差异有统计学意义(χ2=12.825,P<0.01),但阿托伐他汀组≥ 70岁和<70岁亚组患者的造影剂肾病发生率无明显差异(P>0.05)。结论 与瑞舒伐他汀相比,阿托伐他汀对老年患者冠状动脉造影术后肾功能更具保护作用,造影剂肾病的发生率更低,且这种保护作用在≥ 70岁亚组的高龄患者中更明显。
关键词:  瑞舒伐他汀  阿托伐他汀  冠状血管造影术  肾功能  造影剂肾病
DOI:10.16781/j.0258-879x.2018.12.1330
投稿时间:2018-08-30修订日期:2018-11-23
基金项目:上海市卫生系统优秀人才培养计划(2017YQ029).
Effects of rosuvastatin and atorvastatin before coronary angiography on postoperative renal function in elderly patients: a comparative analysis
DOU Hong-wei1△,WANG Guo-wei1△,CHEN Liang1,2,LI Pan1,KAN Tong1,QIN Yong-wen1*
(1. Department of Cardiovasology, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Cardiovasology, No. 904 Hospital of the Joint Logistics Support Force of PLA, Wuxi 214000, Jiangsu, China
Co-first authors.
* Corresponding author)
Abstract:
Objective To explore the effects of preoperative rosuvastatin and atorvastatin on postoperative renal function in elderly patients undergoing coronary angiography. Methods From Jan. 2018 to Jun. 2018, 345 patients undergoing coronary angiography in Department of Cardiovasology of Changhai Hospital of Navy Medical University (Second Military Medical University) were divided into rosuvastatin group (n=171) and atorvastatin group (n=174). The patients in the two groups were further divided into <70 years subgroup and ≥ 70 years subgroup. All patients continued to take the original routine medications and routine dose of statins before bedtime. The serum creatinine levels were measured before and within 72 hours after coronary angiography. The incidence of contrast-induced nephrology was analyzed in each group. Results The postoperative serum creatinine level of the patients in the rosuvastatin group was (99.2±28.9) μmol/L, which was higher than that before operation ([92.2±29.5] μmol/L); and the difference was statistically significant (t=4.734, P<0.01). There were no significant differences in the serum creatinine levels before and after operation in the patients of the atorvastatin group (P>0.05). The postoperative serum creatinine level was significantly higher than that before operation in the rosuvastatin group, regardless of the age of <70 or ≥ 70 years ([88.0±15.6] μmol/L vs[82.3±13.5] μmol/L, t=3.858, P<0.01;[104.8±32.2] μmol/L vs[97.2±33.7] μmol/L, t=3.657, P<0.01). The postoperative serum creatinine level was significantly higher than preoperative one in the patients aged <70 years in the atorvastatin group ([128.3±44.4] μmol/L vs[122.4±43.4] μmol/L, t=2.854, P=0.006), but the postoperative and preoperative serum creatinine levels were not significantly different in the patients aged ≥ 70 years (P>0.05). The incidence of contrast-induced nephrology was significantly higher in the rosuvastatin group than that in the atorvastatin group (21.1%[36/171] vs 6.9%[12/174], χ2=14.430, P<0.01). And the incidence of contrast-induced nephrology in the patients aged ≥ 70 years was significantly higher than that in the patients aged <70 years of the rosuvastatin group (28.9%[33/114] vs 5.3%[3/57], χ2=12.825, P<0.01). Conversely, there was no significant difference in the incidence of contrast-induced nephropathy between the patients aged ≥ 70 years and <70 years in the atorvastatin group (P>0.05). Conclusion Compared with rosuvastatin, atorvastatin has a more potent effect on protecting renal function and reducing the incidence of contrast-induced nephrology in elderly patients after coronary angiography, and this advantage is more obvious in the patients aged ≥ 70 years.
Key words:  rosuvastatin  atorvastatin  coronary angiography  renal function  contrast-induced nephrology