Chen Guang-ling, Su Jin-zi
Department of Cardiology, Affiliated First Hospital, Fujian Medical University, Fuzhou, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2009 May;37(5):389-93.
To study the effects of atorvastatin on contrast induced renal function change and plasma hsCRP in patients undergoing coronary angiography.
120 patients who underwent coronary angiography were randomized to receive atorvastatin (20 mg/qn, n = 60) or no atorvastatin (n = 60) treatment 2 to 3 days before coronary angiography. Urinary alpha1-MG, TRF and mALB were checked for evidence of tubular or glomerular damage at start, 1 day and 2 days after the administration of a radiocontrast agent. Serum creatinine, BUN, cystatin C and hsCRP levels were also assessed at the same time. Ccr and GFR were calculated according to Cockcroft-Gault and GFR (ml/min) = 74.835/Cys C(1.333) formulas basing on serum creatinine or cystatin C concentration.
(1) In control group, comparison with the value before coronary angiography, urinary alpha1-MG, TRF and mALB or serum cystatin C and hsCRP significantly increased at day 1 after angiography (P < 0.01). In comparison to the levels at day 1 after angiography, urinary alpha1-MG, TRF, mALB, serum cystatin C significantly decreased at day 2 after angiography (P < 0.01), but alpha1-MG, cystatin C still exceeded the values before coronary angiography, TRF and mALB levels at day 2 after angiography had no significant change compared to baseline (P > 0.05), hsCRP level at day 2 after angiography had no significant change compared to that at day 1 after angiography (P > 0.05) too. (2) In comparison with the value before coronary angiography in atorvastatin-treated group, the levels of urinary alpha1-MG, TRF and mALB or serum cystatin C at day 1 and day 2 after angiography had no significant change compared to baseline (P > 0.05).Serum hsCRP significantly increased at day 1 after angiography compared to baseline (P < 0.01), but it had no significant change compared to day 2 after angiography (P > 0.05). (3) To compare to the atorvastatin-treated group, the values of urinary alpha1-MG, TRF and mALB or Cys C and hsCRP significantly increased at day 1 after angiography in control group (P < 0.01), the values of urinary alpha1-MG, cystatin C and hsCRP still significantly increased at day 2 (P < 0.01)too, but those of TRF and mALB had no significantly change at day 1 or day 2 after angiography between the two groups (P > 0.05). There was no significant change in BUN, Cr, Ccr levels before and after angiography between the two groups.
Low dose contrast induces light renal function damage. Pretreatment with atorvastatin 20 mg/qn for 2 to 3 days could significantly reduce procedural inflammatory reaction, attenuate urinary protein and the effect of degrading GFR in coronary angiography patients.
研究阿托伐他汀对接受冠状动脉造影术患者对比剂所致肾功能变化及血浆高敏C反应蛋白（hsCRP）的影响。
120例接受冠状动脉造影术的患者在冠状动脉造影术前2至3天被随机分为两组，一组接受阿托伐他汀治疗（20mg/每晚，n = 60），另一组不接受阿托伐他汀治疗（n = 60）。在注射造影剂开始时、注射后1天和2天检查尿α1-微球蛋白（α1-MG）、转铁蛋白（TRF）和微量白蛋白（mALB），以评估肾小管或肾小球损伤情况。同时评估血清肌酐、尿素氮（BUN）、胱抑素C和hsCRP水平。根据Cockcroft-Gault公式以及基于血清肌酐或胱抑素C浓度的公式GFR（ml/min）= 74.835/Cys C(1.333)计算肌酐清除率（Ccr）和肾小球滤过率（GFR）。
（1）在对照组中，与冠状动脉造影术前的值相比，造影术后1天尿α1-MG、TRF和mALB或血清胱抑素C和hsCRP显著升高（P < 0.01）。与造影术后1天的水平相比，造影术后2天尿α1-MG、TRF、mALB、血清胱抑素C显著降低（P < 0.01），但α1-MG、胱抑素C仍超过冠状动脉造影术前的值，造影术后2天TRF和mALB水平与基线相比无显著变化（P > 0.05），造影术后2天hsCRP水平与造影术后1天相比也无显著变化（P > 0.05）。（2）在阿托伐他汀治疗组中，与冠状动脉造影术前的值相比，造影术后1天和2天尿α1-MG、TRF和mALB或血清胱抑素C水平与基线相比无显著变化（P > 0.05）。造影术后1天血清hsCRP与基线相比显著升高（P < 0.01），但与造影术后2天相比无显著变化（P > 0.05）。（3）与阿托伐他汀治疗组相比，对照组造影术后1天尿α1-MG、TRF和mALB或胱抑素C和hsCRP的值显著升高（P < 0.01），造影术后2天尿α1-MG、胱抑素C和hsCRP的值仍显著升高（P < 0.01），但两组造影术后1天或2天TRF和mALB的值无显著变化（P > 0.05）。两组造影术前、后BUN、Cr、Ccr水平无显著变化。
低剂量造影剂可导致轻度肾功能损害。冠状动脉造影术前2至3天每晚服用20mg阿托伐他汀预处理可显著减轻手术中的炎症反应，减少尿蛋白，并减轻对冠状动脉造影患者肾小球滤过率的降低作用。
