Tianjin Medical University, Tianjin, China.
Tianjin Chest Hospital, Tianjin, China.
Perfusion. 2021 Sep;36(6):603-609. doi: 10.1177/0267659120957856. Epub 2020 Sep 10.
Contrast-induced nephropathy (CIN) has become a common cause of hospital-acquired acute kidney injury in elderly patients. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent years, which can reduce the incidence of CIN. This study aimed to evaluate the efficacy of TMZ in the prevention of contrast-induced nephropathy in elderly patients with renal insufficiency undergoing percutaneous coronary intervention (PCI) and to explore the mechanism of action.
A total of 310 elderly patients with renal insufficiency undergoing elective PCI were enrolled and randomly assigned to a control group (n = 155, hydration only) and a TMZ group (n = 155, 20 mg thrice daily orally 24 hours before and 72 hours after PCI). The primary endpoint of the study was the incidence of CIN, which was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dL or more in serum creatinine from baseline value, at 48 to 72 hours following the exposure to contrast media (CM).
The incidence of CIN was significantly lower in the TMZ group than that in the control group (3.2% vs. 9.7%, p = 0.021). There was no difference regarding the incidence of major adverse events during hospitalization between the TMZ group and control group (1.9% vs. 2.6%, p = 1.000). Binary logistic regression results showed that TMZ was protective factors of CIN (OR = 0.274; 95% CI: 0.089-0.847; p = 0.025).
Therefore, we came to the conclusion that prophylactic administration of TMZ can prevent the occurrence of CIN in elderly patients with renal insufficiency undergoing PCI and has a certain protective effect on the renal function of patients. According to the experimental results and the mechanism of TMZ on cardiomyocytes, we speculate that TMZ increases kidney glucose metabolism, reduces fatty acid oxidation, and also has a protective effect on kidney free radical damage and ischemia-reperfusion injury.
对比剂肾病（CIN）已成为老年患者医院获得性急性肾损伤的常见原因。曲美他嗪（TMZ）是近年来开发的一种抗缺血药物，可降低 CIN 的发生率。本研究旨在评估 TMZ 在预防接受经皮冠状动脉介入治疗（PCI）的肾功能不全老年患者对比剂诱导的肾病中的疗效，并探讨其作用机制。
共纳入 310 例接受选择性 PCI 的肾功能不全老年患者，随机分为对照组（n=155，仅水化）和 TMZ 组（n=155，PCI 前 24 小时和后 72 小时口服 20mg，每日 3 次）。研究的主要终点是 CIN 的发生率，定义为暴露于对比剂（CM）后 48 至 72 小时血清肌酐比基线值升高 25%或以上，或绝对值升高 0.5mg/dL 或以上。
TMZ 组 CIN 的发生率明显低于对照组（3.2%比 9.7%，p=0.021）。TMZ 组与对照组住院期间主要不良事件的发生率无差异（1.9%比 2.6%，p=1.000）。二项逻辑回归结果显示，TMZ 是 CIN 的保护因素（OR=0.274；95%CI：0.089-0.847；p=0.025）。
因此，我们得出结论，预防性给予 TMZ 可预防接受 PCI 的肾功能不全老年患者 CIN 的发生，并对患者的肾功能具有一定的保护作用。根据 TMZ 对心肌细胞的实验结果和作用机制，我们推测 TMZ 增加肾脏葡萄糖代谢，减少脂肪酸氧化，对肾脏自由基损伤和缺血再灌注损伤也具有保护作用。
