| BackgroundIn recent years,the incidence of acute myocardial infarction(AMI)was increasing year by year,and the AMI was becoming to be a serious threat and common diseases and frequently-occurring disease to human health,and the percuntaneous coronary intervention,is one of the most important treatment measures of AMI.However,the adverse effects of contrast agents on renal function have become an important question that can not be ignored by a clinician.Contrast-induced nephropathy(CIN)has become one of the common complications after intervention,which is one of the causes of iatrogenic acute renal injury.CIN is currently no effective treatment measures,so the prevention of CIN is particularly critical.There is growing evidence that statins can reduce the incidence of CIN by influencing a variety of factors that contribute to the development of CIN.The possible mechanism of renal protection for statins is through its pleiotropic effects,such as antioxidant,anti-inflammatory and anti-thrombotic effects.PurposeTo evaluate the effect of atorvastatin on renal function,interleukin-18 and cystatin-C in patients with acute myocardial infarction after emergency PCI,and to analyze the possible mechanism.MethodsFrom January 2016 to October 2016,the patients with acute ST segment elevation myocardial infarction underwent emergency percutaneous coronary intervention in Affiliated Hospital of Zunyi Medical College.Based on the preoperative Scr levels were divided into preoperative Scr normal group(A)(SCr = 109umol/L),preoperative elevated Scr group(B)(SCr 110~265.2umol/L).According to the dose of atorvastatin afteroperation,the patients were divided into routine group: conventional atorvastatin 40 mg QD,intensive group atorvastatin 80 mg QD,Scr,Cys-C and IL-18 were detected first,second,third days before operation and after operation respectively.Results1.The baseline clinical data of A group and B group,including age,gender,weight,history of previous diseases,blood lipids and the use of intraoperative contrast media,were not statistically different(P > 0.05).2.Before operation,the level of Cys-C in A group was lower than that in group B [(0.97 +0.25)mg/L vs(1.88 + 0.26)mg/L,P < 0.05],IL-18 level in preoperative A group was lower than that of group B [(96.7 + 27.22)pg/ml vs(215.8 + 30.33)pg/ml,P < 0.05].3.Two groups of postoperative renal function change: A group patients overall Scr,Cys-C levels,postoperative and preoperative comparison,no significant statistical difference(P >0.05).In the A group,the elevated level of Scr in the intensive group was lower than that in the conventional group,and P > 0.05,the difference was not statistically significant.In the A group,the elevated level of Cys-C in the intensive group was lower than that in the conventional group,and P > 0.05,the difference was not statistically significant.The overall Scr and Cys-C levels in the B group were not significantly different between the two groups after surgery(P > 0.05).In the B group,the elevated level of Scr in the intensive group was lower than that in the conventional group,and P > 0.05,the difference was not statistically significant.In the B group,the elevated level of Cys-C in the intensive group was lower than that in the conventional group,and P > 0.05,the difference was not statistically significant.4.Changes of inflammatory mediators after operation: the overall IL-18 level in A group was higher than that before operation,and P > 0.05.The elevated level of IL-18 in the A group was significantly lower than that in the conventional group,P < 0.05.The overall IL-18 level in B group was higher than that before operation,and P > 0.05.In group B,the elevated level of IL-18 in the intensive group was significantly higher than that in the conventional group,P < 0.05.ConclusionIntensive atorvastatin therapy may have a protective effect on CIN in patients with acute myocardial infarction after emergency PCI,and its mechanism may be related to the reduction of inflammatory response. |
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