复方丹参滴丸对冠心病合并糖尿病患者介入治疗后造影剂肾病的预防作用OACSTPCD
Preventive effect of Compound Danshen Dripping Pill on contrast nephropathy after percutaneous coronary intervention among the patients with coronary artery disease complicated with diabetes mellitus
[目的]探讨复方丹参滴丸对冠心病合并糖尿病患者介入治疗后造影剂肾病(CIN)的预防作用.[方法]纳入天津市胸科医院心内三科2022年1月-2023年1月收治的冠心病合并糖尿病且行冠状动脉介入治疗的患者180例,采用简单随机分组方法,将入选患者随机分为观察组(90例)与对照组(90例).对照组患者使用常规水化疗法预防CIN,观察组患者在对照组基础上应用复方丹参滴丸,比较两组患者的CIN发病率差异,比较两组患者治疗前及治疗后72 h肾功能:血肌酐(Scr)、尿素氮(BUN)、计算估算肾小球滤过率(eGFR)、血β2微球蛋白、尿中蛋白与肌酐比值(ACR)以及尿中性粒细胞明胶酶相关性脂蛋白(NGAL),炎性指标包括超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6),氧化应激指标包括超氧化物歧化酶(SOD)水平、丙二醛(MDA)水平的变化.对2组入选患者随访6个月,记录2组患者主要心脏不良事件(MACE)发生情况.[结果]1)复方丹参滴丸组CIN发病率低于对照组(4.4％vs 16.7％),差异有统计学意义(P＜0.05).2)治疗前,两组患者一般情况无差异(P＞0.05).与治疗前相比,两组患者治疗后72 h血肌酐、尿素、血β2微球蛋白、hs-CRP、IL-6、丙二醛水平、尿ACR、尿NGAL水平升高,而eGFR水平、SOD水平降低(P＜0.05).治疗后72 h,观察组肌酐、尿素、血β2微球蛋白、hs-CRP、IL-6、丙二醛水平、尿ACR、尿NGAL水平低于对照组,eGFR水平、SOD水平明显高于对照组(P＜0.05).3)随访6个月,观察组心脏MACE发生率低于对照组(10.0％vs 31.3％),差异有统计学意义(P＜0.05).4)多因素logistic回归分析显示,复方丹参滴丸对预防冠心病合并糖尿病的患者介入术后CIN有保护作用[OR=0.136,95％CI(0.035,0.527),P=0.004].[结论]复方丹参滴丸对预防冠心病合并有糖尿病患者冠状动脉介入治疗后CIN的发生可能起到一定作用.
[Objective]To investigate the protective effect of Compound Danshen Dripping Pills on contrast-induced acute kidney injury(CIAKI)among the patients with coronary artery disease complicated with diabetes.[Methods]One hundred and eighty patients with diabetes and coronary artery disease who were admitted in Tianjin Chest Hospital from January,2022 to January,2023 and scheduled for interventional therapy were randomly divided into observe group(90),receiving additional Compound Danshen Dripping Pills on the basis of the control group,and the control group(90),receiving hydration therapy to prevent CIN.The incidence of contrast nephropathy rate,and the renal function of the two groups before and 72 hours after treatment was compared.The levels of renal function indexes(BUN,Scr,eGFR,β2-microglobulin,ACR and NGAL),inflammatory reaction indexes(hs-CRP,IL-6),and oxidative stress indexes(malondialdehyde and SOD)were measured before and after treatment.The patients were followed up 6 months and record the occurrence of major adverse cardiac events(MACE)in both groups.[Results]1)The treatment group had statistically lower incidence of CIAKI than the control group(4.4％vs 16.7％,P＜0.05).2)Before treatment,no significant differences of clinical background factors between the two groups were found(P＞0.05).The levels of Scr,BUN,β2-microglobulin,hs-CRP,IL-6,malondialdehyde,protein-creatinine ratio(ACR)and neutrophil gelatinase associated lipocalin(NGAL)were significantly increased,while the eGFR and SOD were obviously decreased in both groups in 72 h after treatment(P＜0.05).In 72 h after treatment,the levels of Scr,BUN,β2-microglobulin,hs-CRP,IL-6,malondialdehyde,protein-creatinine ratio(ACR)and neutrophil gelatinase associated lipocalin(NGAL)were notably lower,and the eGFR and SOD were remarkably higher in the Compound Danshen Dripping Pills group than the control group(all P＜0.05).3)Following up for 6 months,the incidence of adverse prognosis in the Compound Danshen Dripping Pills group was lower than that in control group,with significant difference(10.0％vs 31.3％,P＜0.05).4)Multivariate logistic regression analysis showed that Compound Danshen Dripping Pills had positive effect on the prevention of CIAKI[OR=0.136,95％CI(0.035,0.527),P=0.004].[Conclusion]Compound Danshen Dripping Pills may exert certain preventive effect on the development of CIAKI among the patients with diabetes and coronary artery disease in the interventional therapy.
席鹏丽;杨世诚;宫鑫成;英硕;张鹏
天津市胸科医院心内科,天津 300222
临床医学
复方丹参滴丸造影剂肾病经皮冠状动脉介入治疗冠心病糖尿病预防
Compound Danshen Dripping Pillcontrast nephropathypercutaneous coronary interventioncoronary artery diseasediabetes mellitusprevent
《天津中医药》 2024 (008)
963-967 / 5
天津市卫生健康委员会天津市中医药管理局中医中西医结合科研课题(2021205);天津市医学重点建设学科(心血管病学)建设项目(TJYXZDXK-055B).
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