The Clinical Study On Prevention Of Prostaglandin E1 In Contrast Induced Acute Kidney Injury In Senile CHD After Coronary Intervention

Objective: To investigate the effectiveness and mechanism of prostaglandin E1 on prevention of contrast induced acute kidney injury(CIAKI) in senile coronary heart disease(CHD) after percutaneous coronary intervention(PCI).Methods: Three hundred elderly patients with CHD, who were about to undergo PCI in Tianjin Chest Hospital from November 2012 to June 2014, were enrolled to the study. The patients were randomly divided into two groups: prostaglandin E1 treatment group(n=150) and conventional treatment group(n=150). The number of male in the prostaglandin E1 group was 97 and the number of female was 53, the age range of patients was 60~80(68.11±6.16) years; the numbers of male in the conventional treatment group were 98 and female were 52, the age range of patients was 60~79(68.47±6.05) years. The inclusion criteria: the patients who needed to undergo selective PCI, and before undergoing selective PCI a week did not use prostaglandin E1. The exclusion criteria: age<60 years, the patients were allergic to contrast, estimated glomerular filtration rate(e GFR)<30ml/(min·1.73m2), emergency PCI, thyroid dysfunction, the patients who had used contrast, prostaglandin E1 or alprostadil, and nephrotoxic drugs in last tow weeks, serious cardiac insufficiency, serious pulmonary hypertension, acute or chronic infection, autoimmune diseases, electrolyte disturbances, cardiogenic shock, cancer, hypotension. Before PCI and after 6 ~ 12 h, two groups were both treated with isotonic saline at the speed of 1 ml·kg-1·h-1(the patients with heart failure or LVEF <45% at the speed of 0.5 ml·kg-1·h-1) for hydration. Meanwhile, prostaglandin E1 group were received prostaglandin E1(Beijing Tide Pharmaceutical Co., LTD) for 0.5~1h preoperative and 3h postoperative PCI plug hydration treatment, and the conventional treatment group were received only simple hydration treatment. Both groups were gathering basic clinical information(such as age, gender, LVEF, the illness, etc.) and the dose of contrast how much used in the PCI. The data of the renal function [such as serum creatinine(Scr), blood urea nitrogen(BUN), estimated glomerular filtration rate(e GFR), creatinine clearance rate(Ccr) and 24-hour proteinuria] and the data of inflammation factors[such as C-reactive protein(CRP), tumor necrosis factor-α (TNF-α), β2-microglobulin(β2-MG), superoxide dismutase(SOD), interleukin-6(IL-6) and glutathione peroxidase(GPX)] were observed and collected before PCI and after 72 h. Record and analyse the incidengce of CIAKI in the two groups after the PCI and record the adverse reactions of prostaglandin E1 which can induce hypotension.Result: The incidence of CIAKI in the conventional treatment group was obviously higher than the prostaglandin E1 group(8.7% vs 2.7%,χ2=5.051,P=0.025).(2) It has no statistically significant in both of groups with the basic clinical information and contrast dosage(P>0.05).(3) The levels of Scr, e GFR, Ccr, 24-hour proteinuria, BUN, SOD, CRP, TNF-α, GPX, β2-MG and IL-6 have no statistically difference between both groups before PCI(P>0.05).(4) After PCI 72 h, the levels of Scr, Ccr, e GFR, BUN, β2-MG and TNF-α, which were compared with before PCI, have no change significantly(P>0.05).(5) There were no changes of the levels of Scr, BUN, β2-MG and TNF-α in both of groups(P>0.05).(6) The levels of CRP, IL-6, SOD, GPX and 24-hour proteinuria in both of groups after PCI 72 h were higher than the levels before PCI(P<0.05).(7) In the prostaglandin E1 group after PCI 72 h, the levels of CRP, IL-6, SOD, GPX and 24-hour proteinuria that were compared with the conventional treatment group were lower, while the level of Ccr and e GFR was obviously higher(P<0.05).(8) There was no obviously adverse reaction in both of groups.Conclusion: The incidence of CIAKI may be the result of the inflammation and oxidative stress.(2) Prostaglandin E1 has protective effect on renal in the senile CHD after PCI.(3) To the elderly patients with CHD, alprostadil has certain effect on the prevention of CIAKI after PCI. Maybe because of the anti-inflammatory effect, antioxidant effect and the dilate kidney vessels effect, prostaglandin E1 can play a role in the prevention.(4) It is safe to use the prostaglandin E1.