[普罗布考在预防冠状动脉介入术后对比剂诱导的急性肾损伤中的作用：一项随机试验]

[Role of probucol in preventing contrast induced acute kidney injury after coronary interventional procedure: a randomized trial].

作者信息

Yin Li, Li Guang-ping, Liu Tong, Liu Hong-mei, Chen Xin, He Mei, Zheng Xin-tian, Liu En-zhao, Zhou Li-Juan

机构信息

Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2009 May;37(5):385-8.

PMID:19781209

Abstract

OBJECTIVE

Contrast induced acute kidney injury (CIAKI) is a significant clinical problem. We, therefore, performed a prospective, randomized trial to investigate the role of probucol in the prevention of CIAKI in patients with unstable angina pectoris (UAP) undergoing percutaneous coronary angiography (CAG) and interventions (PCI).

METHODS

We studied 205 patients with UAP, who underwent CAG or PCI prospectively. Patients were randomly assigned to probucol group (n = 102) and control group (n = 103). In the probucol group, the patients received probucol tablets 500 mg b.i.d for 3 days before and after intervention. All the patients, after intervention, underwent hydration with intravenous saline at a rate of 1 ml per kilogram of body weight per hour for 12 hours.

RESULTS

Patients were well-matched with no significant difference at baseline in majority measured parameters between two groups. CIAKI occurred in 23 of the 205 (11.22%) patients. Multivariate logistic regression was used to identify correlates of CIAKI and clinical data. CIAKI was most strongly associated with Scr > or = 132.6 micromol/L (OR = 21.11, 95%CI 1.95 - 56.06, P < 0.001), Ccr < 60 ml/min (OR = 4.19, 95%CI 1.94 - 9.05, P < 0.001), heart function > class II (OR = 6.23, 95%CI 2.73 - 14.21, P < 0.001), Diabetes (OR = 2.049, 95%CI 1.19 - 5.25, P < 0.001), age > or = 70 yrs (OR = 3.52, 95%CI 1.66 - 7.43, P < 0.001), coronary artery calcification shown by CAG (OR = 4.29, 95%CI 1.99 - 9.24, P < 0.001). The rate of CIAKI in probucol groups was slightly lower compared with control group (7.84% vs. 14.56%), without significant difference. The post-procedure mean peak of Scr [(101.62 +/- 42.98) micromol/L vs. (117.67 +/- 68.77) micromol/L, P = 0.047] and the post-procedure increasing Scr from baseline (DeltaScr) [(13.49 +/- 19.61) micromol/L vs. (22.50 +/- 18.31) micromol/L, P = 0.001] in the probucol group decreased significantly compared with that of control group.

CONCLUSION

Prophylactic treatment with probucol 500 mg b.i.d during periprocedural stage in patients with UAP has preventing role against CIAKI after cardiac catheterization.

摘要

目的

对比剂诱导的急性肾损伤（CIAKI）是一个重大的临床问题。因此，我们进行了一项前瞻性随机试验，以研究普罗布考在预防接受经皮冠状动脉造影（CAG）和介入治疗（PCI）的不稳定型心绞痛（UAP）患者发生CIAKI中的作用。

方法

我们前瞻性地研究了205例接受CAG或PCI的UAP患者。患者被随机分为普罗布考组（n = 102）和对照组（n = 103）。在普罗布考组中，患者在干预前后3天每天两次服用500 mg普罗布考片。所有患者在干预后以每小时每千克体重1 ml的速率静脉输注生理盐水进行水化治疗12小时。

结果

两组患者在多数测量参数的基线水平上匹配良好，无显著差异。205例患者中有23例（11.22%）发生了CIAKI。采用多因素逻辑回归分析来确定CIAKI的相关因素和临床数据。CIAKI与血清肌酐（Scr）≥132.6 μmol/L（比值比[OR]=21.11，95%可信区间[CI]1.95 - 56.06，P<0.001）、肌酐清除率（Ccr）<60 ml/min（OR = 4.19，95%CI 1.94 - 9.05，P<0.001）、心功能>Ⅱ级（OR = 6.23，95%CI 2.73 - 14.21，P<0.001）、糖尿病（OR = 2.049，CI 1.19 - 5.25，P<0.001）、年龄≥70岁（OR = 3.52，95%CI 1.66 - 7.43，P<0.001）、CAG显示冠状动脉钙化（OR = 4.29，95%CI 1.99 - 9.24，P<0.001）密切相关。普罗布考组的CIAKI发生率略低于对照组（7.84%对14.56%），但无显著差异。与对照组相比，普罗布考组术后Scr的平均峰值[（101.62±42.98）μmol/L对（117.67±68.77）μmol/L，P = 0.047]以及术后Scr较基线的升高幅度（ΔScr）[（13.49±19.61）μmol/L对（22.50±18.31）μmol/L，P = 0.001]均显著降低。