慢性普伐他汀治疗预防心血管疾病伴肾功能不全患者造影剂肾病。

Prevention of contrast-induced nephropathy by chronic pravastatin treatment in patients with cardiovascular disease and renal insufficiency.

机构信息

The Cardiovascular Center, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan.

出版信息

J Cardiol. 2009 Oct;54(2):192-8. doi: 10.1016/j.jjcc.2009.05.006. Epub 2009 Jun 23.

DOI:10.1016/j.jjcc.2009.05.006

PMID:19782255

Abstract

BACKGROUND

Contrast-induced nephropathy (CIN) is known to increase morbidity and mortality of cardiovascular disease. Recent studies have shown statins prevented CIN after contrast media exposure, but optimal statin type and dosage are still unknown.

PURPOSE

The aims of the present study were to evaluate whether chronic pravastatin treatment before scheduled coronary angiography or percutaneous coronary intervention could reduce the incidence of CIN and to elucidate the factors related to CIN in patients with renal insufficiency.

METHODS

We studied 431 consecutive patients with renal insufficiency. One hundred ninety-four patients were receiving pravastatin treatment as standard chronic treatment of hypercholesterolemia. Serum creatinine levels were measured at baseline (pre-procedure) and within 48 h after contrast media exposure (peak post-procedure). CIN was defined as an increase in the serum creatinine values of > or = 25% or > or = 0.5 mg/dl after contrast media exposure. Logistic regression analysis was performed to evaluate the important factors related to CIN using four variables: age, pravastatin, pre-procedure serum creatinine, and contrast volume.

RESULTS

CIN was observed in 36 patients (8.4%). Patients without pravastatin (p<0.01), high level pre-procedure serum creatinine (p<0.01), and high contrast volume (p=0.034) had a significantly higher incidence of CIN. Logistic regression analysis revealed that pravastatin treatment (chi(2)=6.549, p=0.011, odds ratio=0.34), pre-procedure serum creatinine (chi(2)=6.294, p=0.009, odds ratio=2.78), and contrast volume (chi(2)=4.484, p=0.034, odds ratio=1.01) were independently related to the decreased risk of CIN.

CONCLUSIONS

Chronic pravastatin treatment before contrast media exposure was important for preventing CIN in patients with renal insufficiency. Also, reducing the dose of contrast media was important for preventing CIN in patients with high-baseline serum creatinine levels.

摘要

背景

对比剂肾病（CIN）会增加心血管疾病的发病率和死亡率。最近的研究表明，他汀类药物可预防造影剂暴露后的 CIN，但最佳他汀类药物类型和剂量仍不清楚。

目的

本研究旨在评估计划行冠状动脉造影或经皮冠状动脉介入治疗前慢性普伐他汀治疗是否可降低 CIN 的发生率，并阐明肾功能不全患者 CIN 相关的因素。

方法

我们研究了 431 例连续肾功能不全患者。194 例患者接受普伐他汀治疗作为高胆固醇血症的标准慢性治疗。在基线（术前）和造影剂暴露后 48 小时内（术后峰值）测量血清肌酐水平。CIN 定义为造影剂暴露后血清肌酐值增加≥25%或≥0.5mg/dl。使用 4 个变量（年龄、普伐他汀、术前血清肌酐和造影剂用量）进行逻辑回归分析，以评估与 CIN 相关的重要因素。

结果

36 例（8.4%）发生 CIN。未用普伐他汀（p<0.01）、术前高血清肌酐水平（p<0.01）和高造影剂用量（p=0.034）的患者 CIN 发生率显著更高。逻辑回归分析显示，普伐他汀治疗（卡方值=6.549，p=0.011，比值比=0.34）、术前血清肌酐（卡方值=6.294，p=0.009，比值比=2.78）和造影剂用量（卡方值=4.484，p=0.034，比值比=1.01）与 CIN 风险降低独立相关。