The Preventive Effects Of Intensive-dose Atorvastatin On Contrast Induced Acute Kidney Injury In CHD Patients Undergoing Percutaneous Coronary Intervention

Objective:The preventive effects intensive-dose Atorvastatin on Contrast-induced acute kidney injury(CIAKI)in patients with coronary heart disease(CHD)undergoing percutaneous coronary intervention by a multi-center,randomized,controlled clinical research.Methods:783 patients with CHD,who were about to undergo PCI in Teda International Cardiovascular Hospital,Tianjin First Central Hospital,Tianjin Fourth Central Hospital and Tianjin Chest Hospital from January 2015 to December 2016,were enrolled to the study(333 patients were from our hospital,150 patients were from each other three hospitals).The patients were randomly divided into two groups in four hospitals: intensive dose group(A,394 patients)and conventional dose proup(B,389 patients).Patients in group A were given atorvastatin(40mg/day)one day prior to the coronary angiography or angioplasty.Patients in Group B were only given atorvastatin 10 mg once a day.All patients wre given atorvastatin(10mg/day)after 3 days of the procedure.The basic clinical information,treatment usage and the dosage of hydration liquid and contrast agent were collected.The levels of blood urea nitrogen(BUN),serum creatinine(Scr),estimated glomerular filtration rate(e GFR),Cystatin C(Cys C),Homocysteine(Hcy),Neutrophil gelatinase associated apolipoprotein(NGAL),C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),superoxide dismutase(SOD),glutathion(GSH),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)before and72 h after the procedure were collected.Meanwhile,the levels of Scr,e GFR were also collected.Record and analyse the incidengce of CIAKI in the two groups after the PCI.Record adverse reactions of heart and kidney about atorvastatin during hospitalization.Result:(1)Before PCI,there were no significant difference in the basic clinical information,treatment usage and the dosage of hydration liquid and contrast agent between the two groups(P>0.05).(2)Before PCI,the levels of Scr,e GFR,BUN,Cys C,Hcy,CRP,TNF-α,IL-6,NGAL,SOD,GSH between the two groups wrer not different(P > 0.05).(3)In the intensive-dose group,12 patients were diagnosed CIAKI,the incidence was 3.0%.However,in the conventional-dose group,31 patients had CIAKI,the incidence was 8.0%.there was a significant difference in the incidence between the two groups(P<0.05).(4)Compared with the levels of Scr,e GFR before PCI,which could reflect renal function,the levels had no differences48 h or 72 h after PCI(P>0.05).But,the levels of BUN,Hcy,Cys C,NGAL 72 h after PCI were higher than the levels before PCI(P < 0.05).(5)The levels of Inflammatory factors like CRP,IL-6,TNF-α after PCI wre higher than the levels before PCI(P<0.05).(6)The level of SOD was higher than the level before PCI(P<0.05).Meanwhile,the level of GSH was lower than the level before PCI(P<0.05).(7)48h or 72 h after PCI,the levels of Scr,e GFR in intensive-dose group were not significantly different compared wiht the levels in conventional-dose group(P>0.05).the level of Cys C,Hcy,NGAL in intensive-dose group was lower than the level in conventional-dose group(P<0.05).(8)72h after PCI,the levels of CRP,IL-6,TNF-αin intensive-dose group were significantly different compared with the levels in conventional-dose group(P > 0.05).(9)72h after PCI,the level of SOD in intensive-dose group was higher than the level in conventional-dose group(P<0.05).Meanwhile,the level of GSH in intensive-dose group was lower than the level in conventional-dose group(P<0.05).Conclusion:(1)Atorvastatin could protect renal function and prevent CIAKI by inhibiting inflammation and oxidative stress.(2)The effect of intensive-dose atorvastatin in preventing CIAKI is better than conventional dose.It is safe to use high dose of atorvastatin.