辅酶 Q10 联合曲美他嗪预防择期冠状动脉造影术合并肾功能不全的冠心病患者对比剂肾病：随机对照研究及体内研究。

Coenzyme Q10 combined with trimetazidine in the prevention of contrast-induced nephropathy in patients with coronary heart disease complicated with renal dysfunction undergoing elective cardiac catheterization: a randomized control study and in vivo study.

机构信息

Department of Cardiology, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Xinhua District, Shijiazhuang, 050005, Hebei, China.

出版信息

Eur J Med Res. 2018 May 18;23(1):23. doi: 10.1186/s40001-018-0320-2.

DOI:10.1186/s40001-018-0320-2

PMID:29776437

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5960150/

Abstract

BACKGROUND

Contrast-induced nephropathy (CIN) is one of the common hospital-acquired acute renal failures. The purpose of this study was to investigate whether Coenzyme Q10 (CoQ10) and trimetazidine (TMZ) can prevent the occurrence of CIN after elective cardiac catheterization in patients with coronary artery disease complicated with renal dysfunction.

METHODS

Consecutive coronary artery disease patients with renal insufficiency scheduled for coronary angiography were enrolled in randomized, paralleled, double-blind, controlled trial. The development of CIN was occurrence at the 48 or 72 h after the procedure. The changes of serum creatinine (SCr), eGFR, and Cys-C within 72 h after the procedure were measured and compared. In vivo contrast medium (CM)-induced acute kidney injury (AKI) animal model was established, and CoQ10 plus TMZ was orally administrated to evaluate its renal protective effect.

RESULTS

150 patients with renal insufficiency were enrolled finally. CIN occurred in 21 (14.00%) of the 150 patients. 72 h after the procedure, the incidence of CIN was significantly lower in CoQ10 plus TMZ group compared with control group (6.67 vs. 21.3%, p = 0.01). No cardiac death occurred in this study. No side effects were observed after administration of CoQ10 and TMZ. In vivo test demonstrated that CoQ10 and TMZ could significantly reduce the concentration of blood urea nitrogen (BUN) and SCR induced by CM i.v. injection, as well as tubular pathological injuries. Meanwhile, CoQ10 and TMZ could significantly reduce the oxidation stress in kidneys from CM-AKI animals.

CONCLUSION

CoQ10 plus TMZ could decrease the incidence of CIN in patients with renal insufficiency undergoing elective cardiac catheterization, and their effect may be due to its strong anti-oxidation effect.

摘要

背景

对比剂肾病（CIN）是医院获得性急性肾衰竭的常见原因之一。本研究旨在探讨辅酶 Q10（CoQ10）和曲美他嗪（TMZ）是否可以预防伴有肾功能不全的冠心病患者择期心导管检查后 CIN 的发生。

方法

连续入选因肾功能不全拟行冠状动脉造影的冠心病患者，采用随机、平行、双盲、对照临床试验设计。CIN 的发生定义为术后 48 或 72 h 时血肌酐（SCr）、肾小球滤过率（eGFR）和胱抑素 C（Cys-C）的变化。建立体内对比剂（CM）诱导的急性肾损伤（AKI）动物模型，给予 CoQ10 加 TMZ 口服，评价其肾脏保护作用。

结果

最终入选 150 例肾功能不全患者。150 例患者中，21 例（14.00%）发生 CIN。术后 72 h，CoQ10 加 TMZ 组 CIN 的发生率明显低于对照组（6.67%比 21.3%，p=0.01）。本研究中无心脏死亡发生。CoQ10 和 TMZ 给药后未见不良反应。体内试验表明，CoQ10 和 TMZ 可显著降低静脉注射 CM 引起的血尿素氮（BUN）和 SCr 浓度，以及肾小管病理损伤。同时，CoQ10 和 TMZ 可显著降低 CM-AKI 动物肾脏的氧化应激。