Influence Of Different Statins On The Early Renal Function In Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention

Background and Purpose:Since the reform and opening up, along with the continuous improvement ofpeople’s ever-accelerating pace of life and standard of living, diet and lifestylechanges, the occurrence spectrum of human disease and death are quietly changing.Coronary atherosclerotic heart disease has seriously threaten human life and health.Acute coronary syndrome (ACSs) is one clinical type of CHD Intensive. In additionto the general treatment, the methods also including anticoagulant, anti-PLTaggregation drugs and surgery. Intervention is one type of revascularization.Accompanied by the conduct and application of CAG and PCI surgery,the use ofcontrast agents has become even more widespread. Acute kidney injury caused by thecontrast agent also has been increased.Contrast-induced nephropathy(CIN) hasbecome one of the common causes of AKI.In view of the current conventional clinical indicators of renal function,such asBUN, Scr etc. are not sensitive enough to reflect slight damage on early renalfunction. In the test we chose more sensitive indicator of kidney damage, such ascystatin (CysC), microalbuminuria (mALB) and α1-microglobulin (α1-MG) asrelated indicators of changes in renal function. One purpose of this study is to explore an ideal sensitive marker in the early diagnosis of contrast-induced nephropathy (CIN)instead of blood Scr and thus achieve the purpose of early diagnosis and treatment, tomaximum extent the purpose of protecting kidney function. Another purpose of thisstudy is to observe the effects of different doses of statin rosuvastatin and atorvastatinin ACS patients after PCI for renal function in short-term and to analyze the possiblemechanism of action.Materials and Methods:Choose120people from the hospitalized patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention (PCI) from July2012to June2013in the Department of Cardiology,the First Affiliated Hospital of ZhengzhouUniversity, in intensive rosuvastatin group,patients were given rosuvastatin20mg,QN for2-3days before PCI; in intensive atorvastatin group,patients were givenatorvastatin40mg, QN for2-3days before PCI, patients of both groups were reducedto conventional doses after PCI and long-term use of it; and in control group,patientswere given either rosuvastatin10mg,QN or atorvastatin20mg,QN beforePCI, tomaintain the original dose after surgery for long-term. And to detect high-sensitivityC-reactive protein (hsCRP), blood urea nitrogen (BUN), serum creatinine (Scr),serum cystatin C (Cys-C), urinary α1-micro globulin (α1-MG), urinary albumin(mALB), urine osmolality and other indicators respectively before PCI and1,2daysafter PCI.Compared the prevalence of contrast-induced nephropathy(CIN).Results:1. The difference of surgery general information, coronary intervention casesamong three groups was not significant (P>0.05), they are comparable.2. There was no significant change in BUN, Scr, urine osmolality levelscompared to baseline in three groups before PCI and1,2days after PCI. Incomparison with the value before PCI in each group, BUN, Scr, and urine osmolalitylevels at day1after PCI had not significantly change to baseline(P>0.05),the sameresults in day2too. 3. There was no significant difference in baseline urinary α1-MG, urinary mALBand CysC levels in three groups(P>0.05).Comparison with the value before PCI,α1-MG, mALB and CysC significantly increased at day1after PCI((P <0.05), eGFRsignificantly decreased at day1after PCI((P <0.05). In comparison to the day1levelstaken after PCI, α1-MG, mALB and CysC significantly decreased at day2afterPCI((P<0.05),but remined at a higher level. GFR significantly increased at day2afterPCI((P <0.05),but remined at a lower level. Compared to the control group,the valuesof α1-MG, mALB, and CysC significantly decreased at day1after PCI in theintensive statin groups (P<0.05), α1-MG, mALB, and CysC significantly decreased atday2(P<0.05) too.but GFR significantly increased in the intensive statin groups(P<0.05). There was no significantly change in α1-MG, mALB, GFR and CysC at day1or day2after PCI in two intensive statin groups (P>0.05).4. There was no significant difference in baseline CRP levels in three groups(P>0.05). Comparison with the value before PCI, CRP significantly increased at day1after PCI((P<0.05), In comparison to the day1levels taken after PCI, CRPsignificantly increased at day2after PCI((P<0.05). Compared to the control group,the values of CRP significantly decreased at day1after PCI in the intensive statingroups (P<0.05), CRP significantly decreased at day2(P<0.05) too. There was nosignificantly change in CRP at day1or day2after PCI in two intensive statin groups(P>0.05).5Differences between the three groups in the incidence of CIN was nostatistically significant (P>0.05).Conclusion:1. The use of contrast agent in PCI can cause damage to the kidney. Intensivestatin before PCI compared with conventional-dose statin can reduce the renaldamage induced by contrast agent. Statins may protect the kidneys through itsanti-inflammatory effect.2. There was no significant difference between intensive rosuvastatin withintensive atorvastatin in the prevention of CIN. 3. The sensitivity of serum cystatin C (Cys-C), urinary α1-microglobulin(α1-MG), urinary albumin (mALB) are better in terms of reflects early renal functionimpaired in patients after intervention compared with serum creatinine levels (Scr),blood urea nitrogen (BUN), urinary osmolality.