Wang Yong, Shi Yun, Xu Xuesheng, Ge Wenkun, Yang Shuo, Lu Chengzhi
First Center Clinic College of Tianjin Medical University, Tianjin.
Department of Cardiology.
Medicine (Baltimore). 2019 Jun;98(25):e16049. doi: 10.1097/MD.0000000000016049.
This study was performed to explore the effects of probucol on contrast-induced acute kidney injury (CIAKI) in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI).
In total, 220 patients undergoing PCI were randomly assigned to either the control group (hydration from 12 hours before to 12 hours after contrast administration; n = 110) or the probucol group (hydration plus probucol 500 mg twice daily 1 day before and 3 days after the operation; n = 110). The primary endpoint was the occurrence of serum creatinine (Scr)-based CIAKI, defined as an absolute increase in Scr by 0.5 mg/dl (44.2 μmol/L) or a relative 25% increase from baseline within 48 to 72 hours after exposure to contrast medium. The secondary outcomes were composite variations in Scr, blood urea nitrogen (BUN), creatinine clearance rate (Ccr) within 48 to 72 hours, and major adverse events during hospitalization or the 7-day follow-up period after PCI.
The overall incidence of Scr-based CIAKI was 7.3% (16/220): 5.5% (6/110) in the control group and 9.1% (10/110) in the probucol group (χ = 1.078, P = .298). There were no significant differences in the occurrence rate of major adverse events during hospitalization or the 7-day follow-up period after PCI between the groups. Multivariate logistic regression analysis showed that probucol was not an independent protective factor for CIAKI (odds ratio, 1.825; 95% confidence interval, 0.639-5.212; P = .261). However, hydration was an independent protective factor (odds ratio, 0.997; 95% confidence interval, 0.995-0.999; P = .004).
Probucol cannot effectively reduce the incidence of CIAKI through its anti-inflammatory and antioxidative stress effects.
本研究旨在探讨普罗布考对接受经皮冠状动脉介入治疗(PCI)的冠心病患者造影剂诱导的急性肾损伤(CIAKI)的影响。
总共220例接受PCI的患者被随机分为对照组(造影剂注射前12小时至注射后12小时进行水化;n = 110)或普罗布考组(水化加普罗布考500mg,每天两次,术前1天和术后3天;n = 110)。主要终点是基于血清肌酐(Scr)的CIAKI的发生,定义为在接触造影剂后48至72小时内Scr绝对增加0.5mg/dl(44.2μmol/L)或相对于基线增加25%。次要结局是48至72小时内Scr、血尿素氮(BUN)、肌酐清除率(Ccr)的综合变化,以及PCI术后住院期间或7天随访期内的主要不良事件。
基于Scr的CIAKI的总体发生率为7.3%(16/220):对照组为5.5%(6/110),普罗布考组为9.1%(10/110)(χ = 1.078,P = 0.298)。两组在PCI术后住院期间或7天随访期内主要不良事件的发生率无显著差异。多因素逻辑回归分析显示,普罗布考不是CIAKI的独立保护因素(比值比,1.825;95%置信区间,0.639 - 5.212;P = 0.261)。然而,水化是一个独立保护因素(比值比,0.997;95%置信区间,0.995 - 0.999;P = 0.004)。
普罗布考不能通过其抗炎和抗氧化应激作用有效降低CIAKI的发生率。