| Objective: To investigate the value of drug intervention on contrast-inducednephropathy (CIN) in patients with acute coronary syndrome (ACS) undergoing electivecoronary angiography (CAG) or percutaneous coronary intervention (PCI).Methods:132patients with ACS undergoing elective CAG or PCI were selected inthe department of cardiology, Suzhou Kowloon Hospital of Shanghai Jiaotong Universityfrom January2012to January2013. The mean age was (63.45±10.13) years. Among them,95patients were male, and37were female. All patients were randomly divided into threegroups. Group A (41patients) was given atorvastatin20mg/d and0.9%sodium chloridewith the speed of1ml/kg/h from6h before procedure to12h after procedure. Group B (48patients) was given atorvastatin80mg once within24h before procedure besides the drugsof group A. Group C (43patients) was given N-acetylcysteine (NAC)600mg Bid for2days before procedure besides the drugs of group A. The venous blood of all patients weredrawn and the serum creatine levels were measured before procedure and48h～72h afterprocedure, and eGFR were calculated. Urines before and2h、6h、24h and48h afterprocedure were collected for all patients.The neutrophil gelatinase associated lipocalin(NGAL) levels were measured using Enzyme-linked immunospecific assay(ELISA). Theincidence of CIN and the changes of Scr,eGFR and urinary NGAL in the three groupswere observed during the periprocedural period. Binary Logistic regression analysis wasused to analyze the related risk factors of CIN.Results:1. Total of5patients had CIN.The incidence of CIN was3.79%. In group A,the incidence was7.69%(3/41); in group B, no CIN happened (0/48), and in group C, theincidence was4.65%(2/43).There was no significant difference in the incidence of CIN between group A and group C (P>0.05).2. Before procedure, the Scr was（78.45±16.67）umol/L in group A,（76.06±13.52）umol/L in group B and（77.43±14.56）umol/L in group C. There was no significantdifference among the three groups (P>0.05).48～72h after procedure, the Scr was（83.53±17.01）umol/L in groupA,（71.33±13.02）umol/L in group B and（82.89±29.52）umol/L in group C. The Scr in group B decreased significantly compared with that in groupA and group C （P<0.05）. There was no significant difference between group A and groupC (P>0.05). Before procedure, the eGFR was（90.21±21.10）ml/min/1.73m~2in group A,（91.78±24.62）ml/min/1.73m~2in group B and （91.54±17.48）ml/min/1.73m~2in group C.There was no significant difference among the three groups (P>0.05).48～72h afterprocedure, the eGFR was（86.27±17.23）ml/min/1.73m~2in group A,（96.26±27.67）ml/min/1.73m~2in group B and（82.89±29.52）umol/L in group C. The eGFR in group Bincreased significantly compared with group A and group C（P<0.05）. There was nosignificant difference between group A and group C (P>0.05). Before procedure, theurinary NGAL was （3.73±0.72） ng/ml in group A,(3.86±0.69)ng/ml in group Band(3.78±0.56)ng/ml in group C. There was no significant difference among the threegroups (P>0.05).2h after procedure, the urinary NGAL was（3.86±0.99）ng/ml in group A,（4.06±0.79）ng/ml in group B and（4.05±0.74）ng/ml in group C. There was no significantdifference among the three groups (P>0.05).6h after procedure, the urinary NGAL was（5.97±1.07）ng/ml in groupA,（5.20±1.08）ng/ml in group B and（6.02±1.78）ng/ml ingroup C. There was also no significant difference among the three groups (P>0.05).24hafter procedure, the urinary NGAL was（8.85±0.82）ng/ml in group A,（6.45±0.75）ng/mlin group B and（8.79±0.70）ng/ml in group C. The urinary NGAL in group B decreasedsignificantly compared with group A and group C（P<0.05）. There was no significantdifference between group A and group C (P>0.05).48h after procedure, the urinary NGALwas（3.85±0.56）ng/ml in group A,（3.95±0.78）ng/ml in group B and（4.09±0.63）ng/mlin group C. There was no significant difference among the three groups (P>0.05)。3、 Before procedure, the Scr was （81.28±28.32） umol/L in CIN group and（76.49±12.62）umol/L in non-CIN group. There was no significant difference between the two groups (P>0.05).48～72h after procedure, the Scr was（119.78±61.56）umol/L in CINgroup and（77.89±19.67）umol/L in non-CIN group. There was significant differencebetween the two groups（P<0.05）. Before procedure, the eGFR was（91.02±30.79）ml/min/1.73m~2in CIN group and（92.48±20.51）ml/min/1.73m~2in non-CIN group. Therewas no significant difference between the two groups (P>0.05).48～72h after procedure,the eGFR was（63.62±25.03）umol/L in CIN group and（89.56±20.33）umol/L in non-CINgroup. There was significant difference between the two groups （P<0.05）. Beforeprocedure, the urinary NGAL was（4.16±1.03）ng/ml in CIN group and（3.79±0.65）ng/mlin non-CIN group. There was no significant difference between the two groups (P>0.05).2h、6h、24h、48h after procedure, the urinary NGAL in CIN group and in non-CIN groupwas（5.99±1.29）ng/ml and（3.95±0.81）ng/ml;（9.78±1.96）ng/ml and（5.66±1.44）ng/ml；（15.06±1.84）ng/ml and（7.96±1.73）ng/ml；（6.06±1.75）ng/ml and（3.96±1.52）ng/ml. There were significant differences between the two groups（P<0.05）.4.Advanced age,diabetes mellitus and the used volume of contrast medium were theindependent risk factors of CIN.Conclusions:1. Taking80mg atrovastatin once on the basis of hydration and20mgatrovastatin before procedure can prevent acute kidney injury and decrease the incidence ofCIN.2. Taking NAC600mg Bid before procedure for two days on the basis of hydrationand20mg atrovastatin can not prevent the incidence of CIN.3. Urinary NGAL might be an earlier biomarker for the prediction of CIN for patientswith ACS undergoing elective CAG or PCI．4.Advanced age,diabetes mellitus and the used volume of contrast medium are the... |
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