经皮冠状动脉介入治疗中应用酚妥拉明与慢性肾脏病和慢性冠状动脉综合征患者冠状动脉造影后转归良好的关系：一项前瞻性随机对照研究
Association of periprocedural phentolamine infusion with favorable outcome in patients with chronic kidney disease and chronic coronary syndrome undergoing coronary catheterization: a prospective randomized controlled pilot study.
机构信息
Critical Care Medicine, Beni Suef University, Beni Suef, Egypt.
Critical Care Medicine, Cairo University, Cairo, Egypt.
出版信息
BMC Nephrol. 2022 Dec 31;23(1):416. doi: 10.1186/s12882-022-03050-9.
BACKGROUND
Chronic kidney disease (CKD) is a major risk factor for contrast induced acute kidney injury (CI-AKI) in chronic coronary syndrome (CCS) patients undergoing coronary catheterization. We aimed to evaluate the efficacy of phentolamine in prevention of CI-AKI in CKD and CCS patients undergoing percutaneous coronary catheterization for diagnostic angiography ± stenting.
METHODS
Participants with CKD and CCS planned for percutaneous coronary catheterization were included, while participants with normal kidney functions were excluded. A consecutive sample of 107 participants (mean age 58.62 ± 8.96 years, 64.5% males) was selected, underwent diagnostic coronary angiography or percutaneous coronary intervention, and received either conventional CI-AKI prevention strategy (group 1) or periprocedural phentolamine and conventional CI-AKI prevention strategy (group 2).
RESULTS
The percentages of study participants who had CI-AKI were 82.9% for group 1 and 17.1% for group 2, respectively. The incidence rate of CI-AKI was significantly lower in group 2 versus group 1 (p < 0.001). The urine output (ml/kg) and the urine output (ml/hour) within 72 hours post procedure was significantly higher in group 2 versus group 1 (t(105) = - 0.69, p < 0.001, t(105) = - 52.46, p < 0.001, respectively), the peak change in serum creatinine and the percentage of change relative to the baseline serum creatinine at 72 hours post procedure was significantly lower in group 2 versus group 1 (t(102) = 0.2, p 0.018, t(102) = 23.54, p < 0.001, respectively), and the incidence rate of major adverse cardiac and cerebrovascular events within 90 days post procedure was significantly lower in group 2 versus group 1 (t(102) = 1.168, P < 0.001), respectively. There was a statistically significant association of periprocedural phentolamine infusion with prevention of CI-AKI (OR = 0.041, 95% CI 0.0149-0.1128, P < 0.0001).
CONCLUSION
Our study highlights the potential role of phentolamine for protection of the kidney in CKD patients planned for coronary catheterization.
TRIAL REGISTRATION
Pan African Clinical Trial Registry Number: PACTR202209493847741. Date of Trial Registration: 22/09/2022.
背景
慢性肾脏疾病（CKD）是慢性冠状动脉综合征（CCS）患者行冠状动脉造影检查时对比剂诱导急性肾损伤（CI-AKI）的主要危险因素。我们旨在评估酚妥拉明在预防接受经皮冠状动脉导管术进行诊断性血管造影术±支架置入术的 CKD 和 CCS 患者 CI-AKI 中的疗效。
方法
入选计划行经皮冠状动脉导管术的 CKD 和 CCS 患者，排除肾功能正常的患者。连续入选 107 例患者（平均年龄 58.62±8.96 岁，64.5%为男性），行诊断性冠状动脉造影或经皮冠状动脉介入治疗，分别接受常规 CI-AKI 预防策略（第 1 组）或经皮冠状动脉介入治疗时给予酚妥拉明和常规 CI-AKI 预防策略（第 2 组）。
结果
第 1 组和第 2 组 CI-AKI 的发生率分别为 82.9%和 17.1%。第 2 组 CI-AKI 的发生率明显低于第 1 组（P<0.001）。第 2 组患者术后 72 小时内的尿量（ml/kg）和尿量（ml/hour）明显高于第 1 组（t（105）=-0.69，P<0.001，t（105）=-52.46，P<0.001），术后 72 小时内血清肌酐的峰值变化和与基线血清肌酐的变化百分比明显低于第 1 组（t（102）=0.2，P<0.018，t（102）=23.54，P<0.001），术后 90 天内主要不良心脑血管事件的发生率明显低于第 1 组（t（102）=1.168，P<0.001）。经皮冠状动脉介入时给予酚妥拉明与预防 CI-AKI 呈统计学显著相关（OR=0.041，95%CI 0.0149-0.1128，P<0.0001）。
结论
我们的研究强调了酚妥拉明在预防计划行冠状动脉导管术的 CKD 患者发生肾损伤方面的潜在作用。
试验注册
泛非临床试验注册中心编号：PACT202209493847741。试验注册日期：2022 年 9 月 22 日。
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