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口服尼可地尔对急性ST段抬高型心肌梗死患者直接PCI术后对比剂肾病的预防作用

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目的 探讨急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)围
手术期口服尼可地尔对术后对比剂肾病(CIN)发生率的影响。方法 本研究连续入选2016年9月至2018年
1月就诊于河北省邢台市人民医院心脏内科的STEMI患者260例,随机分为尼可地尔组132例和对照组128
例。尼可地尔组的患者在确诊STEMI后给予10 mg尼可地尔口服,而后以一次10 mg、2/d的剂量连续服用3
d;对照组给于除尼可地尔以外的其他标准药物治疗。所有患者于入院后即刻、术后24 h、48 h、72 h及7 d
时化验血清肌酐(SCr)及胱抑素-C(Cys-C)。研究终点为直接PCI后CIN的发生和术后7 d内SCr及Cys-C
的变化。结果 本研究共有41例(15.77%)患者在直接PCI后发生CIN。尼可地尔组CIN的发生率明显低于
对照组(10.61% vs. 21.09%,P=0.031)。两组患者的SCr和Cys-C在术后24、48及72 h均较基线水平明显
升高,在术后7 d时均恢复至基线水平;尼可地尔组术后48 h和72 h的SCr和Cys-C均明显低于对照组(P均
<0.05),在术后24 h和7 d时两组患者的SCr和Cys-C均无统计学差异(P均>0.05)。结论 STEMI患者直
接PCI围手术期口服尼可地尔能够明显减少术后CIN的发生率,为CIN的预防提供了新的药物选择。

Abstract:

 Objective To investigate the influence of oral nicorandil on the incidence rate of contrastinduced
nephropathy (CIN) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergone
primary percutaneous coronary intervention (pPCI) during preprocedural period. Methods STEMI patients (n=260)
undergone pPCI were chosen from Department of Cardiology in People’s Hospital of Xingtai City of Hebei Province
from Sept. 2016 to Jan. 2018, and then divided randomly into nicorandil group (n=132) and control group (n=128).
The nicorandil group was orally given nicorandil (10 mg) after definite STEMI diagnosis followed by nicorandil (10
mg once) and twice a day for 3 d continuously. The control group was given other drugs except of nicorandil. The
levels of serum creatinine (SCr) and serum cystatin C (Cys C) were detected at time points of immediate time after
admission and after pPCI for 24 h, 48 h, 72 h and 7 d in all groups. The study endpoint was CIN incidence after PCI
and the changes of SCr and Cys-C within 7 d after pPCI. Results There were 41 patients (15.77%) with CIN after
pPCI. The incidence rate of CIN was significantly lower in nicorandil group than that in control group (10.61% vs.
21.09%, P=0.031). The levels of SCr and Cys-C increased significantly compared with baseline in 2 groups after
24 h, 48 h and 72 h, and recovered to baseline level after 7 d. The levels of SCr and Cys-C were significantly lower
in nicorandil group than those in control group after 48 h and 72 h (all P<0.05). The levels of SCr and Cys-C had
no statistical difference between 2 groups after 24 h and 7 d (all P>0.05). Conclusion Nicorandil taken orally in
perioperative period of pPCI can significantly reduce the postoperative incidence rate of CIN in STEMI patients,
which provide a new drug choice for preventing CIN.

基金项目:

河北省卫生和计划生育委员会科研基金项目青年科技课题(20171463)

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