Multi-center Clinical Research Of Preventive Effect Of Probucol On Contrast Induced Acute Kidney Injury In Patients With Coronary Heart Disease After PCI

Objective:To investigate the preventive effect,mechanism and safety of probucol on contrast induced acute kidney injury(CIAKI)in CHD patients after percutaneous coronary intervention(PCI)based on multi-center clinic data.Methods:The study enrolled 641 patients who underwent PCI in Tianjin Chest Hospital,Tianjin First Center Hospital,Tianjin Fourth Center Hospital and Tianjin Teda Internaional Cardiovascular Hospital from November 2015 to November 2016.All patients were randomly divided into 2 groups: probucol group(n=321)and conventional group(n=320).From one day before PCI to three days after PCI,patients in probucol group were given probucol 500 mg bid po while patients in conventional group were given conventional treatment.Then the data of the basic clinical information of patients was collected.Then we use a CIAKI risk assessment system to devide two groups into low-risk subgroups(178&175)、mean-risk subgroups(112&116)and high-and-overhigh-risk subgroups(31&29).The levels of BUN,Scr,Cys-C,eGFR,hs-CRP,IL-6,SOD,GSH,NGAL and TNF-αwere measured in two groups at admission and 48 h and 72 h after PCI.Finally,the incidence of CIAKI and the adverse reactions of probucol were observed during hospitalization and two weeks after PCI of follow-up.Results:1.The basic clinical information of two groups was no difference(P>0.05);The basic clinical information of all corresponding subgroups of two groups was no difference(P>0.05).There was no difference in the levels of Scr,BUN,Cys-C,eGFR,hs-CRP,IL-6,SOD,GSH,NGAL and TNF-α among all corresponding subgroups of two groups before PCI(P>0.05).2.The incidence of CIAKI in probucol group was lower than conventional group(P<0.05).3.Compared to those before PCI,the levels of Scr,BUN and Cys-C of all subgroups of two groups increased 48 h and 72 h after PCI,and the levels of eGFR of those decreased(P<0.05).4.Compared to the corresponding ones of conventional group 48 h and 72 h after PCI,the levels of BUN and Cys-C of three subgroups in probucol group were lower(P<0.05),and the level of Scr of low-risk subgroup and mean-risk subgroup was lower(P < 0.05).Though the difference of the level of Scr between two high-and-overhigh-risk subgroups was not statistically significant(P>0.05)48h and 72 h after PCI,the level of increasing Scr(△Scr)of high-and-overhigh-risk subgroup in probucol group was lower(P<0.05).The levels of eGFR of low-risk group and mean-risk group in probucol treatment group are higher(P<0.05).There is no significance between the level of eGFR of high-and-overhigh-risk subgroups in two groups(P>0.05).5.Compared to those before PCI,the levels of hs-CRP,IL-6,NGAL,SOD,GSH of two groups increased 72 h after PCI.Compared to corresponding subgroups of conventional group 72 h after PCI,the levels of hs-CRP,IL-6 and NGAL of three subgroups in probucol group were lower(P<0.05),and the levels SOD and GSH of those were higher(P<0.05).There was no difference in the levels of TNF-α among corresponding subgroups of two groups(P>0.05).6.Compared to those before PCI,the levels of Cys-C and NGAL increased higher among patients with CIAKI than without CIAKI 72 h after PCI(P<0.05).All the patients didn’t develop significant liver damage,muscle damage,gastrointestinal discomfort,Q-T interval prolongation and other adverse events.Conclusions:1.The use of probucol during the perioperative of PCI may induce the incidence of CIAKI,and it has a better protective effect during low-risk and mean-risk patients.2.The inflammation and oxidative stress induced by the use of contrast may be the main pathogenesis of CIAKI.3.The treatment of probucol have played an affective protective role on kidney may be because of anti-inflammation and antioxidantion.4.It is safe to use probucol.