The Protection Of Intensive-dose Rosuvastatin On Contrast Media-induced Acute Kidney Injury In Patients Of Diabetes With Microalbuminuria

BackgroundWith the development of medical iconography, more and more diagnosis and treatment must use contrast agents,especilly in cardiology,PCI (percutaneous coronary intervention) technology has become a routine therapy of coronary artery disease. so,contrast agents kidney injury must be regarded in our work.ObjectiveTo investigate the protection of intensive-dose rosuvastatin on contrast media-induced acute kidney injury in patients of diabetes with microalbuminuria.Methods92 patients of diabetes with microalbuminuria undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) in Anyang City People’s Hospital were enrolled to study.The serum creatinine(Scr)and blood urea nitrogen(BUN) of patients were in nomal limits.Patients were randomly divided to conventional treatment group(n=46) or intensive treatment group(n=46).The conventional treatment group were recived rosuvastatin (10mg/qn)from 2 days before CAG or PCI to 2days after CAG or PCI, accordingly, the intensive treatment group were recived rosuvastatin(20mg/qn)from 2 days before CAG or PCI to 2 days after operation.The levels of Scr, BUN, microalbuminuria, hs-CRP,cystatinC were measured prospectively before CAG or PCI and the first day,third day,One week after CAG or PCI.Meanwhile,observe the incidence of CIN or CI-AKI after the CAG or PCI and the adverse reactions of rosuvastatin in two groups.Result1. Conventional treatment group:comparison with the level before CAG or PCI,mALB,CysC and hs-CRP increased at day 1,3after CAG or PCI(P<0.05).At day 7 after CAG or PCI, mALB and CysC decreased to the preoperative level(P>0.05), but the hs-CRP remained at a higher level(P< 0.05).There was no significant change in Scr,BUN levels compared to baseline before CAG or PCI and 1,3,7days after CAG or PCI.2. Intensive treatment group:comparison with the level before CAG or PCI,mALB, CysC and hs-CRP increased at day lafter CAG or PCI(P<0.05).At day 3 after CAG or PCI,mALB decreased to the preoperative level(P>0.05), but the hs-CRP and CysC remained at a higher level(P< 0.05).At day 7 after CAG or PCI, CysC also decreased to the preoperative level(P> 0.05), but the hs-CRP remained at a higher level(P< 0.05).There was no significant change in Scr,BUN levels compared to baseline before CAG or PCI and 1,3,7days after CAG or PCI.3. Comparison between two groups:there was no significant change in Scr,BUN, mALB, CysC,hs-CRP levels compared to baseline before CAG or PCI in two groups.At day 1 after CAG or PCI, hs-CRP of intensive treatment group was lower than that of conventional treatment group(P< 0.05),but mALB and CysC were no significant difference(P>0.05).At day 3 after CAG or PCI, hs-CRP,mALB and CysC of intensive treatment group were lower than those of conventional treatment group(P<0.05).At day 7 after CAG or PCI, hs-CRP of intensive treatment group was lower than that of conventional treatment group(P<0.05), mALB and CysC were no significant difference(PResult1. Conventional treatment group:comparison with the level before CAG or PCI,mALB,CysC and hs-CRP increased at day 1,3after CAG or PCI(P<0.05).At day 7 after CAG or PCI, mALB and CysC decreased to the preoperative level(P>0.05), but the hs-CRP remained at a higher level(P< 0.05).There was no significant change in Scr,BUN levels compared to baseline before CAG or PCI and 1,3,7days after CAG or PCI.2. Intensive treatment group:comparison with the level before CAG or PCI,mALB, CysC and hs-CRP increased at day lafter CAG or PCI(P<0.05).At day 3 after CAG or PCI,mALB decreased to the preoperative level(P>0.05), but the hs-CRP and CysC remained at a higher level(P< 0.05).At day 7 after CAG or PCI, CysC also decreased to the preoperative level(P> 0.05), but the hs-CRP remained at a higher level(P< 0.05).There was no significant change in Scr,BUN levels compared to baseline before CAG or PCI and 1,3,7days after CAG or PCI.3. Comparison between two groups:there was no significant change in Scr,BUN, mALB, CysC,hs-CRP levels compared to baseline before CAG or PCI in two groups.At day 1 after CAG or PCI, hs-CRP of intensive treatment group was lower than that of conventional treatment group(P< 0.05),but mALB and CysC were no significant difference(P>0.05).At day 3 after CAG or PCI, hs-CRP,mALB and CysC of intensive treatment group were lower than those of conventional treatment group(P<0.05).At day 7 after CAG or PCI, hs-CRP of intensive treatment group was lower than that of conventional treatment group(P<0.05), mALB and CysC were no significant difference(P>0.05).4. According to the standard for diagnosis of CIN,two cases of the conventional treatment group,the occurring rate was 4.3%,meanwhile,one case of the intensive treatment group,the occurring rate was 2.2%,there was no obvious significant(P>0.05).According to the standard for diagnosis of CI-AKI,three cases of the conventional treatment group,the occurring rate was 6.5%,meanwhile,one case of the intensive treatment group,the occurring rate was 2.2%,there was no obvious significant(P>0.05). 5.There was no case that appear ALT elevations three times more than normal and muscle pain,rhabdomyolysis.Conclusion1.mALB and CysC are more sensitive than the Scr、BUN to reflect early renal damage in patients of diabetes with microalbuminuria.2.Intensive-dose rosuvastatin in preventing the contrast media-induced acute kidney injury is better than conventional-dose rosuvastatin in patients of diabetes with microalb-uminuria.The prevention mechanism may be due to the anti-inflammation effects of rosu-vastatin.3.The effect of intensive-dose rosuvastatin in anti-inflammation is better than conventional-dose rosuvastatin4.It is safe to use intensive-dose rosuvastatin(20mg) in short time.