The Preventive Effects Of Probucol On Contrast Induced Acute Kidney Injury In Elderly CHD Patients Undergoing Percutaneous Coronary Intervention

Objective:To investigate the preventive effects of probucol on contrast induced acute kidney injury(CIAKI)after percutaneous coronary intervention(PCI)in elderly patients with coronary heart disease(CHD)through a multi-center,large-sample randomized controlled trial,and its potential mechanism and the drug-related safety.Method:A total of 490 elderly patients with CHD(age>60years)undergoing PCI were consecutively rolled.The patients were selected from January 2016 to December2017 in the Department of Cardiology of Tianjin Chest Hospital,Tianjin TEDA International Cardiovascular Hospital,Tianjin First Central Hospital,Tianjin Fourth Central Hospital.Randomly divided all patients into two groups: probucol group and control group,242 cases in the probucol group,and 248 cases in the control group.Probucol group was given oral probucol 500 mg twice a day from 1 day before to 3days after operation.The control group received hydration only.The basic data(such as age,sex,smoking history and past medical history)were collected,and the basic medication during hospitalization and the contrast agent dosage were recorded.The serum levels of blood urea nitrogen(BUN),serum creatinine(Scr),estimated glomerular filtration rate(eGFR),hypersensitive C-reactive protein(hs-CRP)and cystatin C(Cys C),neutrophil gelatinase associated lipocalin(NGAL),tumor necrosis factor-alpha(TNF-α),superoxide dismutase(SOD),glutathione(GSH)were recorded before and 72 hours after operation in two groups.The incidence of CIAKI was calculated in both groups,and serious adverse reaction of probucol during hospitalization and follow-up were observed.Result:1.There was no significant difference in the basic data and contrast medium dosage between two groups before PCI(P>0.05).2.There was no significant difference in serum Scr,eGFR,BUN,hs-CRP,Cys C,NGAL,TNF-α,SOD and GSH levels before PCI between the two groups(P>0.05).3.The level of Scr in the two groups was higher than that before operation.Thelevel of Scr in the control group was significantly higher than that in the probucol group.The difference was statistically significant(P<0.05).4.Compared with preoperative 72 h after PCI,the levels of BUN,Cys C,NGAL,SOD,GSH,hs-CRP and TNF-α in the two groups were higher than before operation,and the difference was statistically significant(P<0.05).5.The levels of BUN,Cys C,NGAL,SOD,GSH and hs-CRP in probucol group and control group at 72 h after PCI were statistically significant(P<0.05),however,there was no significant difference in TNF-α levels(P>0.05).6.At 72 h after PCI,the eGFR levels in both groups were lower than those before operation,and the differences were statistically significant(P<0.05).7.A total of 45 cases of CIAKI occurred after PCI,with a total incidence of9.1%;13 cases of CIAKI occurred in the probucol group,the incidence was 5.4%,32 cases of CIAKI occurred in the control group,and the incidence was 12.9%.There was a statistically significant difference in the incidence of the two groups(P<0.05).Conclusion:1.The occurrence of CIAKI may be related to oxidative stress and inflammatory reaction.2.For elderly CHD patients undergoing elective PCI,the addition of probucol can reduce the incidence of CIAKI.3.Probucol has a protective effect on renal function,which may be related to its anti-oxidative and anti-inflammatory effects.4.No obvious adverse reactions were observed during the medication.