| Objective To study the protective effects of different doses of atorvastatin on Acute Kidney Injury (AKD) and inflammatory reaction in patients with high risk of contrast-induced nephropathy (CIN) undergoing percutaneous coronary intervention (PCI). Methods 83 patients who underwent PCI were randomly divided into 80 mg statin group (n = 27), 40 mg statin group (n = 28) and 20 mg statin group (n = 28). Each group of patients respectively received atorvastatin 80 mg, 40 mg and 20 mg per day from admission to the day before PCI. All patients'serum creatinine (Scr), blood urea nitrogen (BUN), cystatin C (Cys C), hs-CRP, plasma fibrinogen (fib), interleukin-6 (IL-6), adiponectin (APN), urinaryα1-MG, TRF and mALB were measured at admission, 24 and 48 hours after PCI. GFR was calculated according to GFR (ml/min) = 74.835 / Cys C 1.333 formula basing on cystatin C concentration. CIN was defined as a postprocedure increase in serum creatinine of≥0.5 mg/dl or≥25 % from baseline. And the incidence of CIN was calculated according to the clinic data. Results The baseline data and procedure features were not significantly different statistically among the three groups ( P>0.05). (1) There was no significant difference in BUN, Scr levels compared among and within the three groups ( P>0.05). (2) The preprocedural levels of GFR and Cys C were similar in the three groups (P>0.05). Comparing with the baseline levels, GFR and Cys C had no significant change after PCI in the 40 mg and 80 mg statin groups (P>0.05). But GFR significantly decreased at 24 hours after PCI (P<0.05), and was lower than that in the 40 mg and 80 mg statin groups in the 20 mg statin group (P<0.05). GFR recovered to baseline level at 48 hours after the procedure (P>0.05 compared with the baseline level). In the 20 mg statin group, Cys C significantly increased at 24 hours after PCI (P<0.05), and was higher than that in the 80 mg statin group (P<0.05). Cys C decreased to baseline level at 48 hours after the procedure (P>0.05). (3) The urinaryα1-MG, TRF and mALB levels at admission were not significantly different among the three groups (P>0.05). In the 80 mg statin group, these three items had no significant change after the procedure compared to baseline (P>0.05). In the 40 mg statin group, urinaryα1-MG significantly increased at 24 hours after PCI (P<0.05), and recovered to baseline level at 48 hours after PCI (P>0.05). In the 20 mg statin group, urinaryα1-MG significantly increased after the procedure (P<0.05), and was higher than that in the 80 mg statin group (P<0.05). In the 40 mg and 20 mg statin groups, urinary TRF and mALB significantly increased after the procedure (P<0.05). At 24 hours after PCI, urinary TRF and mALB were significantly higher in the 20 mg statin group than that in the 40 mg and 80 mg statin groups (P<0.05), urinary mALB was greater in the 40 mg statin group than that in the 80 mg statin group (P<0.05). At 48 hours after PCI, the levels of urinary TRF were not significantly different among the three groups (P>0.05), urinary mALB was higher in the 20 mg statin group than that in the 40 mg and 80 mg statin groups (P<0.05). (4) Incidences of CIN in the 80 mg statin group, 40 mg statin group and 20 mg statin group were 11.1%, 10.7% and 35.7% respectively. Cases of CIN in these three groups were 3, 3 and 10. The patients in the 20 mg statin group had a higher incidence of CIN than that in the 40 mg and 80 mg statin groups (P<0.05). (5) The levels of hs-CRP, Fib, IL-6 and APN at admission were not significantly different among the three groups (P>0.05). At 24 and 48 hours after the procedure, hs-CRP and IL-6 significantly increased (P<0.05), and were higher in 20 mg statin group than that in the 40 mg and 80 mg statin groups (P<0.05). At 48 hours after PCI, Fib significantly increased in the three groups (P<0.05). At 24 hours after the procedure, fib also increased in the 20 mg statin group (P<0.05). At 24 and 48 hours after the procedure, the levels of fib were higher in 20 mg statin group than that in the 40 mg and 80 mg statin group (P<0.05). APN significantly decreased after the procedure compared with the baseline in the three groups (P<0.05). At 24 hours after PCI, the level of APN in the 20 mg statin group had become significantly lower than that in the 80 mg statin group (P<0.05). At 48 hours after PCI, APN was significantly lower in the 20 mg statin group than that in the 80 mg and 40 mg statin groups (P<0.05). (6)△D1 represents the difference between the levels at 24 h after PCI and the baseline levels.△D1 of GFR was negatively correlated with△D1 of IL-6 (r=-0.784, P<0.05), and was positively correlated with△D1 of APN (r=0.407, P<0.05).Conclusions (1) During perioperative period, contrast medium can induce AKI. (2) Pretreatment with high dosage of atorvastatin can improve renal function, reduce urinary protein, prevent contrast-induced nephropathy and attenuate procedural inflammatory reaction. (3) The mechanism of CIN may relate to inflammation. Atorvastatin may be through anti-inflammation to reduce renal damage. |
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