| Objective:To observe the protection and possible mechanism of different dose of Simvastatin on renal function in patients with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI).Methods: From October 2009 to December 2010, a total of 162 ACS patients admitted in our hospital underwent elective PCI were enrolled into this randomized study(84 patients without renal dysfunction; 78 patients with mild renal dysfunction). Exclusion criteria: (1) Hypersensitivity to contrast medium (CM) and statins; (2) Infectious diseases, autoimmune diseases and cancer; (3) previous CM exposure within 7 days or statins within previous two weeks of study entry; (4) Severe hepatic or renal insufficiency, New York Heart Association functional class IV , and hemodynamic instability; (5)Age>75; (6)Stenosis of renal artery (unilateral stenosis>70% or bilateral stenosis >50%). The 84 patients without renal dysfunction were randomly divided into Group A and Group B. The 78 patients with mild renal dysfunction were randomly divided intoGroup A and Group B. Patients in Group A received 20 mg simvastatin daily 3 days before PCI. Patients in Group B received 40 mg simvastatin daily 3 days before PCI. Aspirin, clopidogrel, low molecular weight heparin and nitrates were administered as rutine Cardiac angiography and PCI were completed by radial or ulnar artey. Non-ionic low-osmolar CM and Endeavor drug-eluting stents were used in PCI. Intravenous injection of hydration were given to all patients before PCI.The levels of serum creatinine (Scr), endogenous creatinine clearance rate (Ccr), C-reactive protein (CRP) as well as urinaryα1-microglobulin (α1-MG) were detected at one day before and the 1st, the 2nd and the 3rd days after PCI, respectively. Data were analyzed using SPSS 13.0 software. P<0.05 was considered statistically significant.Results:1 There was no significant difference in age, gender, body mass index, smoking, high blood pressure, diabetes, cholesterol, low density lipoprotein cholesterol, serum creatinine, endogenous creatinine clearance rate, blood urea nitrogen, ejection fraction, and drug use between Group A and Group B in both group without renal dysfunction and group with mild renal dysfunction (all P >0.05).2 All of the PCI were successfully performed. There was no significant difference in coronary lesions, the amount of CM and the amount of hydration fluid (all P>0.05) between Group A and Group B in both group without renal dysfunction and group with mild renal dysfunction.In the group without renal dysfunction , one patient (2.4%) of Group A occurred CIAKI after PCI; and patients of Group B did not occur CIAKI. In the group with mild renal dysfunction, two patients (5.1%) of Group A and one patient (2.6%) of Group B occurred CIAKI.3 Changes of renal function in the group without renal dysfunctionGroup A: The levels of Scr (μmol/L) at the time of baseline, the 1st, the 2nd and the 3rd day after PCI were 92.61±16.37, 113.03±19.91, 100.06±19.04, 93.36±16.51. The level of Scr was significantly increased at the 1st day after PCI, significantly decreased at the 2nd day, and returned to the baseline level at the 3rd day. The levels of Ccr (ml/min) were 90.09±9.21, 79.73±10.18, 88.63±8.89, 89.86±9.03. The level of Ccr was significantly decreased at the 1st day after PCI , significantly increased at the 2nd day, and returned to the baseline level at the 3rd day. The levels of urinaryα1-microglobulin (μg/ml) were 3.09±1.64, 3.83±1.99, 3.47±1.86, 3.06±1.63. The level of urinaryα1-MG was significantly increased at the 1st day after PCI, significantly decreased at 2nd day, and returned to the baseline level at 3rd day. Group B: The levels of Scr (μmol/L) at the time of baseline, the 1st, the 2nd and the 3rd day after PCI were 97.26±17.78,109.86±19.35,98.33±18.80,97.79±17.94. The level of Scr was signifycantly increased at the 1st day after PCI, significantly decreased at the 2nd day, and returned to the baseline level at 3rd day. The levels of Ccr (ml/min) were 88.75±9.87, 81.43±10.24, 88.03±10.15, 88.52±9.69. The level of Ccr was significantly decreased at the 1st day after PCI, significantly increased at the 2nd day, and returned to the baseline level at the 3rd day. The levels of urinaryα1-microglobulin (μg/ml) were 3.52±1.62, 3.76±1.80, 3.43±1.68, 3.23±1.63. The level of urinaryα1-MG was significantly increased at the 1st after PCI, significantly decreased at 2nd day, and returned to the baseline level at 3rd day. There was no significantly difference in the renal indicators before and after PCI between two groups. However, compared with Group A, there was the trend of further improvement in the indicators of Group B.4 Changes of renal function in group in the group with mild renal dysfunctionGroup A: The levels of Scr(μmol/L) at the time of baseline, the 1st , the 2nd and the 3rd day after PCI were 110.78±34.56, 131.45±41.95, 120.94±36.79, 111.89±34.67. The level of Scr was significantly increased at the 1st day after PCI, significantly decreased at the 2nd day, and returned to the baseline level at the 3rd day. The levels of Ccr(ml/min) were 58.27±15.73, 47.53±12.85, 56.74±15.38, 58.03±15.65. The level of Ccr was significantly decreased at the 1st day after PCI, significantly increased at the 2nd day, and not returned to the baseline level at the 3rd day. The levels of urinaryα1-microglobulin(μg/ml) were 3.63±1.30, 4.31±1.51, 3.94±1.38, 3.94±1.38. The level of urinaryα1-MG was significantly increased at the 1st day after PCI, significantly decreased at the 2nd day, and returned to the baseline level at the 3rd day. Group B: The levels of Scr (μmol/L) at the time of baseline,the 1st , 2nd and 3rd day after PCI were 108.48±34.40, 125.37±44.31, 114.38±40.80, 109.09±34.77. The level of Scr was signifycantly increased at the 1st day after PCI, significantly decreased at the 2nd day, and returned to the baseline level at the 3rd day. The levels of Ccr(ml/min) were 57.04±15.55, 49.72±13.14, 56.59±15.40, 56.85±15.39. The level of Ccr was significantly decreased at the 1st day after PCI, significantly increased at the 2nd day, and returned to the baseline level at the 3rd day. The levels of urinaryα1-microglobulin(μg/ml) were 3.57±1.36, 4.19±1.53, 3.78±1.41, 3.59±1.34. The level of urinaryα1-MG was significantly increased at the 1st day after PCI, significantly decreased at the 2nd day, and returned to the baseline level at the 3rd day. There was no significantly difference in renal indicators before and after PCI between two groups. However, compared with Group A, there was the trend of further improvement in the indicators of Group B.5 Changes of CRP before and after PCIThe concentrations of CRP (mg/dl) of Group A in Group without renal dysfunction at the time of baseline,the 1st ,the 2nd and the 3rd day after PCI were 2.40±1.95, 3.21±2.43, 3.34±2.47,3.32±2.46. The concentrations of CRP (mg/dl) of Group B were 2.63±1.98, 3.09±2.24, 3.23±2.30, 3.29±2.27. The concentrations of CRP of both of the two groups were significantly increased at the 1st day after PCI. Compared with the 1st day, there were no significant changes in CRP at the 2nd and the 3rd day. There was no significantly difference in CRP before and after PCI between two groups. However, compared with Group A, there was the trend of further improvement in CRP of Group B.The concentrations of CRP (mg/dl) of Group A in Group with mild renal dysfunction at the time of baseline, the 1st , the 2nd and the 3rd day after PCI were 2.60±1.97, 3.45±2.39, 3.59±2.45,3.63±2.46. The concentrations of CRP (mg/dl) of Group B were 2.44±1.75, 2.92±1.99, 3.09±2.04, 3.15±2.00. The concentrations of CRP of both of the two groups was significantly increased at the 1st day after PCI. Compared with the 1st day, there were no significant changes in CRP at the 2nd and the 3rd day. There were no significantly differences in CRP before and after PCI between two groups. However, there was the trend of further improvement in CRP of Group B compared with Group A.6 Changes of LDL-C before and after taking SimvastatinThe concentrations of LDL-C (mmol/L) of Group A in Group without renal dysfunction before and after taking Simvastatin were 3.66±0.82 and 3.61±0.84. The concentrations of LDL-C (mmol/L) of Group B were 3.42±0.81 and 3.40±0.80. There was no significantly difference in LDL-C before and after taking Simvastatin. The concentrations of LDL-C (mmol/L) of Group A in Group with mild renal dysfunction before and after taking Simvastatin were 3.48±0.93 and 3.45±0.93. The levels of LDL-C(mmol/L) of Group B were 3.56±0.91 and 3.54±0.90. There was no significantly difference in LDL-C before and after taking Simvastatin too.Conclusion:1 Pretreatment with Simvastatin 3 days before PCI can alleviate the renal impairment of glomerular and tubular caused by CM effectively in both groups of without renal dysfunction and with mild renal dysfunction.2 Protection of simvastatin on renal function may be dose-dependent.3 Simvastatin inhibits C-reactive protein, reduces inflammation, which indicates that simvastatin protects renal function beyond lipid-lowering effect. |
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