The Renal Protective Effect Of Alprostadil Combined With Hydration Treatment On Diabetic Nephropathy Patients After PCI

Objective: This study is designed to investigate the renal protective effect of intravenous alprostadil combined with hydration treatment for diabetic nephropathy patients who accepted PCI through observing the change of value of Cys-C,Scr,e GFR and β2-MG between pre-PCI(t0) and at the different time of post-PCI.Methods: From June 2013 to December 2014,107 patients with diabetic nephropathy from the cardiovascular department of the second affiliated hospital of He Bei Medical University underwent PCI were selected as subject. All patients use Ultravist Solution as contrast agent. 54 patients were randomized to alprostadil group( experimental group)( average age 63.38±8.82) and 53 patients to saline group(control group)( average age 66.14±9.38).All patients were routinely given the basic treatment, such as antiplatelet, anticoagulation, regulate lipid, control BP, Hypoglycemic and expanding coronary. From 12 h pre-PCI to 12 h post-PCI,all patients were given 0.9% sodium chloride(1ml/kg/h) for hydration treatment. In alprostadil group, alprostadil was given 20 ug for intravenous Pre-PCI,and then recorded the heart rate and blood pressure. At the 12 h, 36 h and 60 h of post-PCI, alprostadil was given 20 ug respectively. In saline group, the same dose of placebo(0.9% sodium chloride 2ml)were given at the same time.The observation index: the value change of Cys-C,Scr,e GFR and β2-MG at the different time of post-PCI that is 24h(t1),48h(t2),72h(t3)compared to the value of pre-PCI(t0). The adverse effects of alprostadil such as allergic reaction,heart failure,blood pressure drops,phlebitis, arrhythmia,dizziness,headache,fever and gastrointestinal bleeding were observed.Results :1 There were no significant difference of the baseline clinical characteristics and biochemical index between the two groups( P>0.05).2 Compared with pre-PCI, the value of Scr in saline group was significantly increased at the different time of post-PCI(P<0.05);and in alprostadil group, the increase was not significantly(P>0.05). The increase of Scr in alprostadil group was smaller Compared with saline group at the different time of post-PCI(P<0.05).3 Compared with pre-PCI, the value of Cys-c and β2-MG in saline group was significantly increased at the different time of post-PCI(P<0.05);and in alprostadil group, the increase of Cys-c and β2-MG was not significantly(P>0.05). The increase of Cys-c and β2-MG in alprostadil group was smaller Compared with saline group at the different time of post-PCI(P<0.05).4 Compared with pre-PCI, the value of e GFR in saline group was significantly decreased at the different time of post-PCI(P<0.05);and in alprostadil group, the decrease of e GFR was significantly too(P<0.05). The decrease of e GFR in alprostadil group was smaller than that in saline group at the different time of post-PCI(P<0.05).5 In alprostadil group, there was only 1 patient happened mild phlebitis and two patients had mild pruritus at the injection site. No patients suffering from other adverse effect.Conclusion:1 Compared with hydration treatment group,the level of Cys-C, β2-MG and Scr were significantly lower in alprostadil combined hydration group. The e GFR level was significantly higher in combined group than that in hydration group. Alprostadil combined hydration is effective in protecting the renal function in patients with diabetic nephropathy underwent PCI.2 Alprostadil was safe when used in patients who have coronary artery disease with DN underwent PCI.