The Preventive Effect Of Intensive-dose Of Atorvastatin And Probucal On Contrast Induced Acute Kidney Injury

Objective:To investigate the preventive effects, mechanism and safety of intensive-dose of atorvastatin and the combination of conventional-dose of atorvastatin and probucol on contrast induced acute kidney injury(CIAKI) in patients undergoing percutaneous coronary intervention(PCI) and discover which one is better. Methods:The study enrolled 330 patients who underwent PCI in Tianjin Chest Hospital from February 2013 to June 2015. All patients were randomly divided into 3 groups: conventional-dose of atorvastatin(group A,n=110), intensive-dose of atorvastatin(group B,n=110) and the combination of conventional-dose of atorvastatin and probucol(group C,n=110). From the day before PCI, patients in Group A, B and C were given atorvastatin 20 mg Qn, atorvastatin 40 mg Qn and atorvastatin 20 mg Qn and probucol 250 mg Tid respectively. From forth days after PCI, all patients were given atorvastatin 20 mg Qn. Then the data of the basic clinical information of patient and the dosage of contrast was collected. The levels of BUN, Scr, Cysc, e GFR, hs-CRP, IL-6, SOD, MDA, ALT and AST were measured in these three groups at admission and 72 h after PCI. Finally, the incidence of CIAKI and the adverse reactions of atorvastatin and probucol were observed during hospitalization and 3 month after PCI of follow up. Results:1.The incidence of CIAKI in group B and group C were lower than group A(P<0.05), but there was no difference between group B and group C(P>0.05).2.The basic clinical information of three groups was no difference(P>0.05).3.There were no difference in the levels of Scr, BUN, Cysc, e GFR, hs-CRP, IL-6, SOD, MDA, ALT and AST among the three groups before PCI(P>0.05).4.Compared to those before PCI, the levels of Scr,BUN and Cysc of group A and group C increased at 72 h after PCI, but e GFR decreased(P<0.05); the levels of BUN,Cysc of group B increased at 72 h after PCI(P<0.05), while Scr and e GFR were similar(P>0.05).5.Compared to those before PCI, the levels of hs-CRP,IL-6 and MDA of group A and group C increased at 72 h after PCI, but SOD decreased(P<0.05); the levels of hs-CRP, SOD and MDA of group B increased at 72 h after PCI(P<0.05), while IL-6 was similar(P>0.05).6. At 72 h after PCI, the levels of Scr and Cysc of group B and group C were lower than group A, and Cysc of group B was lower than group C(P<0.05);the levels of BUN of group B were lower than group A, and e GFR was higher than group A(P<0.05),but BUN and e GFR of group C were similar to those of group A and group B(P>0.05).7. At 72 h after PCI, the levels of hs-CRP,IL-6 and MDA of group B and group C were lower than that of group A, and group B was lower than group C(P<0.05); the levels of SOD of group B and group C were higher than that of group A(P<0.05),but there was no difference between group B and group C(P>0.05).8. At 72 h after PCI, the levels of ALT and AST of three groups were similar,and that were to those before PCI(P>0.05). All the patients didn’t develop significant liver damage, muscle damage, gastrointestinal dwascomfort, Q-T interval prolongation and other adverse events. Conclusions:1.The inflammation and oxidative stress induced by the use of contrast may be the main pathogenesis of CIAKI.2.The use of intensive-dose of atorvastatin and the combination of conventionaldose of atorvastatin and probucol during the perioperative of PCI may induce the incidence of CIAKI, and intensive-dose of atorvastatin has better protective effect on kidney.3.Intensive-dose of atorvastatin and the combination of conventional-dose of atorvastatin and probucol have better protective effect on renal may be because of anti-inflammation and antioxidantion.4.It is safe to use atorvastatin and probucol.