摘要
目的探讨中药制剂肾康注射液对老年慢性肾病患者造影剂肾病(contrast-induced nephropathy,CIN)防治的安全性和有效性。方法将206例老年慢性肾病拟行冠状动脉造影的患者按照随机数字表法分为水化组(67例)、肾康组(71例)和对照组(68例)。水化组手术前后12 h,均予0.9%氯化钠注射液静脉滴注。肾康组予肾康注射液静脉滴注,对照组予静脉滴注5%葡萄糖,两组均术前3天及术后应用4天,每天1次。观察各组患者CIN的发生率,以及术前、术后24、96 h肌酐、尿素氮、血清胱抑素C(serum cystatin C,Cys C)、肾损伤分子-1(kidney injury molecule-1,KIM-1)和β2-微球蛋白(β2-microglobulin,β2-MG)肾功能指标改变。通过Sperman相关性分析,比较年龄、性别、肾康注射液、造影剂用量、术前肾功能指标水平与24 h肌酐变化值(术后24 h-术前)、CIN发生率的相关性,并进行Logistic回归分析。结果与水化组及对照组比较,肾康组患者CIN发病率明显降低,差异有统计学意义(χ2=5.32,P<0.05)。与本组治疗前比较,治疗24、96 h后3组患者肌酐和Cys C水平均升高(P<0.05),水化组和对照组KIM-1升高(P<0.05),肾康组β2-MG水平升高(P<0.05);与对照组比较,肾康组术后24 hβ2-MG升高(P<0.05),其他指标组间比较,差异均无统计学意义(P>0.05)。肾康治疗与CIN发生率和24 h肌酐变化呈负相关(r=-0.612、-0.517,P<0.05)。造影剂用量与CIN发生率和24 h肌酐变化呈正相关(r=0.644、0.562,P<0.05)。造影剂用量增加使CIN发生率升高(P<0.05),肾康治疗后CIN发生率明显降低(P<0.05)。结论中药制剂肾康注射液对老年肾功能不全患者CIN起到一定的防治作用,降低CIN的发生率。
Objective To explore the safety and effectiveness of Shenkang Injection（SI） for contrast-induced nephropathy（CIN） in elderly patients with chronic kidney disease（CKD）. Methods Totally 206 elderly CKD patients who were scheduled to undergo coronary angiography（CAG） were assigned to three groups according to random digit table, i.e., the rehydration therapy group（67 cases）, the SI group（71 cases）, and the control group（68 cases）. Patients in the rehydration therapy group received intravenous dripping of normal saline 12 h before and after CAG. Patients in the SI group received intravenous dripping of SI, while those in the control group received intravenous dripping of 5%glucose injection. SI and 5% glucose injection was respectively used 3 days before CAG and 4 days after CAG, once per day. The incidence rate of CIN, and levels of creatinine, blood urea nitrogen（BUN）, serum cystatin C（Cys C）, kidney injury molecule-1（KIM-1）, and β2-microglobulin（β2-MG） were detected before CAG, 24 h and 96 h after CAG, respectively. Age, sex, SI, contrast dose, pre-CAG indicators of renal function were compared. Their correlations with changed24-h creatinine value（the difference between the value at post-CAG 24 h and pre-CAG） and CIN incidence rate were analyzed using Sperman correlation and Logistic regression analyses. Results Compared with the rehydration therapy group and the control group, the incidence rate of CIN was significantly lower in the SI group（χ2= 5. 32, P 〈0. 05）.Compared with before treatment in the same group, levels of creatinine and Cys C were all elevated in the 3 groups after 24-and 96-h treatment（P 〈0. 05）; the KIM-1 level increased in rehydration therapy group and the control group（P 〈0. 05）; β2-MG level increased in the SI group（P 〈0. 05）. Compared with the control group, post-CAG β2-MG level increased in the SI group（P 〈0. 05）. There was no statistical difference in other index（P 〈0. 05）. SI was negatively with the incidence rate of CIN and changed 24-h creatinine value（r =- 0. 612,- 0. 517, P 〈0. 05）. The contrast dose was positively with the incidence rate of CIN and changed 24-h creatinine value（r = 0. 644, 0. 562, P 〈0. 05）. Increased contrast dose could elevate the incidence rate of CIN（P 〈0. 05）. SI could obviously lower the incidence rate of CIN（P 〈0. 05）. Conclusion SI could lower the incidence rate of CIN in elder CKD patients by playing certain roles in prevention and treatment.
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2016年第7期792-796,共5页
Chinese Journal of Integrated Traditional and Western Medicine
基金
总后勤部卫生部医学科技青年培育项目(No.13QNP174)
关键词
肾康注射液
老年患者
造影剂肾病
Shenkang Injection
elderly patient
contrast-induced nephropathy
作者简介
通汛作者：夏云峰，Tel：010-66848711，E-mail：xiayf3691@sina.com
