| Background and ObjectiveAt present,the treatment of coronary heart disease mainly includes drug intervention,coronary interventional surgery and surgical bypass.Compared with drug therapy and surgical bypass surgery,coronary intervention has obvious advantages which has small trauma,short time,and remarkable curative effect.Especially in patients with acute myocardial infarction,early opening of occlusion blood vessels greatly improves the prognosis and reduces the mortality rate of coronary heart disease.Coronary intervention with in China has also been rapidly developed has been widely used in world.With the increase of contrast agent usage,Contrast induced nephropathy(CIN)has become the third leading cause of acute kidney injury in hospitals,which increases the risk of hospitalization and renal dialysis treatment for patients and also aggravates the medical burden of individual and country.With the improvement of living standards,people’s diet structure has also undergone major changes,and the prevalence of hyperuricemia,which is not only associated with coronary heart disease,but also is connected with other diseases.A large number of studies have found that increased blood uric acid is an independent risk factor for CIN.For the prevention and treatment of CIN,studies have found that preoperative hydration,the use of isotonic contrast agents,N-acetylcysteine and some drugs such as vitamin C,trimetazidine,theophylline,atrial natriuretic peptide and prostaglandin E1 may have some curative effects on the prevention of CIN,but the clinical efficacy is not exact,and the research results are also very controversial.The prevention and treatment of CIN still need further research.Studies have found that hyperuricemia is an independent risk factor for coronary heart disease and CIN,but there are few studies on whether hypouricemia can prevent the occurrence of contrast-induced nephropathy at home and abroad.This study intends a preoperative urate-lowering therapy in patients with coronary heart disease complicated with hyperuricemia undergoing coronary intervention in our hospital and to record the changes in preoperative and postoperative renal function indicators,adverse reaction events of uric acid lowering drugs and the incidence of CIN,and to explore the preventive effect of uric acid lowering therapy on CIN in patients with coronary heart disease complicated with hyperuricemia.Materials and methods1.Objectives:A total of 100 patients with coronary heart disease and hyperuricemia who underwent coronary artery intervention in the Second Affiliated Hospital of Zhengzhou University from January 2017 to February 2018 were selected.The inclusion criteria refer to the diagnostic criteria of coronary heart disease in China and the Expert Consensus on Hyperuricemia and Gout Treatment in China.Patient’s age,gender,body mass index(BMI),smoking,hypertension,hyperlipidemia,diabetes,glomerular filtration rate(GFR),low-density lipoprotein(LDL-C),and aspirin,clopidogrel were recorded./ ticagrelor,angiotensin converting enzyme inhibitor / angiotensin receptor blocker(ACEI / ARB),beta-blocker were recorded.2.Grouping method:Patients with coronary heart disease complicated with hyperuricemia were randomly divided into the experimental group and the control group.Coronary intervention was performed by two experienced cardiovascular intervention specialists.Blood glucose,serum creatinine,serum uric acid and Cys-C levels were measured by fasting blood at 48 hours before surgery and 72 hours after surgery.The occurrence of adverse events within 72 hours after surgery was recorded.3.Statistical method:Statistical analysis was performed using SPSS 20.0 statistical software.Measurement data between the two groups were expressed as mean ± standard deviation(± s).Dose data were compared between the two groups using an independent sample t test.Paired t-test was used before and after surgery in the group.The count data is expressed as a percentage(%),using the 2 test,and the fisher exact probability method is used for t less than 5.Multivariate stepwise backward logistic regression was used to analyze the correlation between various risk factors and CIN.P < 0.05 was considered statistically significant.Results(1)Pre-operative serum creatinine(89.54±7.37 vs 88.18±9.92),blood urea nitrogen(5.24±0.79 vs 5.16±0.81),blood uric acid(487.40±70.76 vs 496.20±76.90)and Cys-C(1.26)There was no significant difference in the level difference between ±0.21 vs 1.31±0.24(P>0.05).There were no significant differences in serum creatinine(91.54±9.54 vs 90.72±9.72)and blood urea nitrogen(5.38±0.82 vs 5.32±0.79)between the two groups(P>0.05).However,the blood uric acid(454.20±79.69 vs 497.60±79.78)and Cys-C(1.27±0.24 vs 1.41±0.27)levels in the experimental group were significantly lower than those in the control group at 72 hours after surgery(P<0.05).(2)Differences in serum creatinine(89.54±7.37 vs 91.54±9.54),blood urea nitrogen(5.24±0.79 vs 5.38±0.82)and Cys-C(1.26±0.21 vs 1.27±0.24)before and after surgery in the experimental group.There was no statistical significance(P>0.05).The postoperative blood uric acid level was lower than that of preoperative(487.40±70.76 vs 454.20±79.69)(P<0.05).There were no differences in serum creatinine(88.18±9.92 vs 90.72±9.72),blood urea nitrogen(5.16±0.81 vs 5.32±0.79)and serum uric acid(496.20±76.90 vs 497.60±79.78)before and after surgery in the control group.The significance(P>0.05);postoperative Cys-C(1.31±0.24 vs 1.41±0.27)level increased,the difference was statistically significant(P<0.05).(3)There was no significant difference in the incidence of CIN between the two groups(18% vs 22%)within 72 hours after surgery(P>0.05).(4)Multivariate stepwise backward logistic regression analysis found that the contrast agent dosage of contrast agent(OR=1.426,95% CI(1.097,1.853)),age(OR=1.362,95% CI(1.030,1.802)),LDL-C(OR= 1.988,95% CI(1.239,3.190))and postoperative 72 h Cys-C(OR=3.374,95% CI(2.482,4.581))were all risk factors for postoperative CIN(P<0.05).Conclusion1.Preoperative uric acid therapy can not reduce the incidence of CIN in patients with coronary heart disease and hyperuricemia.2.Preoperative uric acid lowering treatment can inhibit the increase of serum Cys-C level,which may have a protective effect on renal function.3.The contrast agent dosage of contrast agent,age,LDL-C and postoperative 72 h Cys-C were all risk factors for postoperative CIN. |
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