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目的观察瑞舒伐他汀对老年冠心病患者造影剂肾病(CIN)的预防作用和对血脂的影响。方法 2014年1月~2014年12月确诊的老年冠心病患者114(男67,女47)例,年龄61~83岁,随机分为常规治疗组(n=57)和瑞舒伐他汀组(n=57)。瑞舒伐他汀组在常规治疗的基础上加服瑞舒伐他汀,每晚20 mg,连续8周。两组分别于造影前、造影后24 h、72 h和7 d测定尿素氮(BUN)及血肌酐(SCr)水平并计算内生肌酐清除率(CCr),同时测定血脂水平。结果造影前常规治疗组与瑞舒伐他汀组肾功能无显著差异,但瑞舒伐他汀组血脂明显低于常规治疗组(P<0.05,P<0.01)。常规治疗组造影后24 h、72 h BUN和SCr明显高于造影前(P<0.05,P<0.01),而CCr则明显降低(P<0.01),血脂无明显变化,这些变化均于7 d后恢复正常。瑞舒伐他汀组造影后仅SCr在24 h、72 h较造影前升高(P<0.05),BUN和CCr无明显变化。常规治疗组发生CIN 6例(11%)于7 d后恢复,瑞舒伐他汀组无发生CIN病例,与常规治疗组CIN发生率比较有显著差异(P<0.05)。两组造影前后血脂均无显著变化。两组不良反应发生率无统计学差异。结论瑞舒伐他汀对老年冠心病患者具有降血脂作用和对CIN有显著预防作用。
Objective To observe the preventive effect of rosuvastatin on contrast-induced nephropathy (CIN) in elderly patients with coronary heart disease and its effect on serum lipids. Methods A total of 114 elderly patients (67 males and 47 females) with coronary heart disease diagnosed from January 2014 to December 2014 were enrolled in this study. Patients (aged 61-83 years) were randomly divided into two groups: conventional treatment group (n = 57) and rosuvastatin group n = 57). Rosuvastatin group was given rosuvastatin on the basis of routine treatment, 20 mg every night for 8 weeks. Blood urea nitrogen (BUN) and serum creatinine (SCr) levels were measured at 24 h, 72 h and 7 d after angiography, and endogenous creatinine clearance (CCr) were calculated. Lipid levels were also measured. Results There was no significant difference in the renal function between the conventional treatment group and the rosuvastatin group before administration, but the rosuvastatin group was significantly lower than the conventional treatment group (P <0.05, P <0.01). The levels of BUN and SCr at 24 h and 72 h after radiotherapy in the conventional treatment group were significantly higher than those before angiography (P <0.05, P <0.01) and CCr (P <0.01) After returning to normal. In the rosuvastatin group, SCr was only increased at 24 h and 72 h compared with before angiography (P <0.05), but there was no significant change in BUN and CCr. 6 cases (11%) of CIN recovered in the conventional treatment group and recovered after 7 days. There was no CIN in the rosuvastatin group, which was significantly different from that in the conventional treatment group (P <0.05). Before and after the two groups of blood lipids did not change significantly. There was no significant difference in the incidence of adverse reactions between the two groups. Conclusion Rosuvastatin has anti-hyperlipidemic effect and a significant preventive effect on CIN in elderly patients with coronary heart disease.