| Objective: To investigate the effects of short-term application of fasudil on contrast-induced acute kidney injury(CI-AKI)in patients with coronary atherosclerotic heart disease(CHD)after percutaneous coronary intervention(PCI)and the related factors for CI-AKI occurrence.Methods: 160 cases of CHD patients scheduled for elective PCI in department of cardiology of Luzhou TCM Hospital from June 2017 to June 2018 were selected for the study and divided into the observation group(n=80)and the control group(n=80)according to the random number table method.The control group at 3d before PCI was slowly pumped 50 ml saline through peripheral vein with q12 H once and 30 min for each pump,and was continuously treated for 7d after operation.And the observation group at 3d before PCI was slowly pumped 30mg(2ml)fasudil injection and 48 ml saline through peripheral vein with q12 H once and 30 min for each pump,and was continuously treated for 7d after operation.The two groups were given hydration at 6h before PCI contrast agent and within 12 h after PCI contrast agent,The specific scheme is to divide the hydration time into three sections:(1)The first time period:6H before puncture,continuous hydration;(2)The Second time period: the puncture begins to the first push contrast agent,stop hydration;(3)The Third time period: 12 H after the first injection of contrast agent,continuous hydration.The method of hydration was continuous intravenous infusion of normal saline at the speed of 1.0ml/kg/h.and the rate was halved for heart failure patients with New York cardiac function grading≥grade Ⅱ,and patients were given anti-platelet aggregation,lipidstabilizing plaque,nitrate crown expansion and other conventional drug treatment.In addition to the above drugs,all patients was no longer given other drugs intravenously or orally at 3d before operation and at 7d after operation but they were given normal eating and drinking so as to avoid strenuous activities and maintain a daily urination volume of 1000-2000 ml.All patients were given 300 mg aspirin enteric-coated tablets and 300 mg clopidogrel hydrogen sulfate tablets for loading dose therapy before PCI,and were given 75mg/d of clopidogrel hydrogen sulfate tablets and 100mg/d aspirin enteric-coated tablets for long-term maintenance therapy,and the drugs were from same drug manufacturers with the same dosage form.All patients were treated with 20 mg qn of atorvastatin calcium tablets(same manufacturer,same brand,same dosage form)before operation.Furthermore,clinicians according to the individual condition of patients should choose the drugs such as β receptor antagonist,calcium channel blockers(CCB),angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor antagonist(ACEI/ARB),nitrates and diuretics.and intraoperative contrast agent was iodixanol.The baseline data,incidence rate of postoperative CI-AKI,and the renal injury indexes,serum inflammatory factors,oxidative stress indexes and vascular endothelial function indexes before operation and at 1d,3d and 7d after operation were compared between the two groups,and the occurrence of adverse reactions within 3 months after operation were recorded in the two group,and multivariate Logistic regression analysis was performed to analyze the risk factors of CI-AKI.Results:(1)There was no significant difference in the baseline data such as basic information,combined disease condition,routine examination and the medication use after admission between the two groups(n=80,P>0.05),but the baseline data were comparable in the two groups.(2)There were 11 cases of CI-AKI in 160 patients with morbidity of 6.88%,including 2 cases in the observation group with morbidity of 2.50% and 9 cases in the control group with morbidity of 11.25%,and the morbidity of CI-AKI in the observation group was lower than that in the control group(n=80,P<0.05).(3)The levels of Scr and BUN in the two groups at 3d and 7d after operation were significantly higher than those before operation(n=80,P<0.05),and the increase degree in the observation group was lower than that in the control group(n=80,P<0.05).The levels of KIM-1 and NGAL in the two groups at 1d,3d and 7d after operation were significantly higher than those before operation(n=80,P<0.05),and the increase degree in the observation group was lower than that in the control group(n=80,P<0.05).The level of Cys-C in the two groups at 1d and 3d after operation was significantly higher than that before operation(n=80,P<0.05),and the increase degree in the observation group was lower than that in the control group(n=80,P<0.05).(4)The levels of serum hs-CRP,IL-6 and TNF-α in the two groups at 1d,3d and 7d after operation were significantly increased compared with those before operation(n=80,P<0.05),and the levels in the observation group at the same time point after operation were lower than those in the control group(n=80,P<0.05).(5)The SOD activity and MDA level in the observation group at 1d and 3d after operation were significantly higher than those before operation(n=80,P<0.05),and the SOD activity in the observation group was higher than that in the control group while the MDA level was lower than that in the control group(n=80,P<0.05).The level of GPX in the observation group at 3d after operation was significantly higher than that before operation(n=80,P<0.05),and the level of GPX in the observation group was higher than that in the control group(n=80,P<0.05).(6)The levels of serum NO and ET-1 at 1d,3d and 7d after operation in the observation group were significantly higher than those before operation(n=80,P<0.05),and the serum NO level was increased while the ET-1 level was decreased in the observation group compared with those in the control group at the same time period(n=80,P<0.05).(7)Within 3 months of postoperative follow-up,no severe adverse reactions such as intracranial hemorrhage,hypotension and shock were found in the two groups.In the control group,there were 1 case of skin petechia,2 cases of gingival bleeding and 2 cases of abdominal distension,and incidence rate of adverse reactions was 6.25%.In the observation group,there were 2 cases of skin petechia,2 cases of gingival bleeding,2 cases of rash and 4 cases of abdominal distension,and the incidence rate of adverse reactions was 12.50%.There was no significant difference in the incidence rate of adverse reactions between the two groups(n=80,P>0.05).(8)Multivariate Logistic regression analysis showed that older age,combined diabetes,G3 a and G3 b chronic renal insufficiency and higher volume of contrast agent were independent risk factors for CI-AKI occurrence(P<0.05),and higher RBC count and fasudil use were protective factors for CI-AKI occurrence(P<0.05).Conclusions:(1)Fasudil for CHD patients scheduled for elective PCI can effectively reduce the morbidity of CI-AKI,and significantly improve the postoperative renal injury,and it is with role of renal protection.(2)Fasudil can play a role of renal protection by improving postoperative serum levels of inflammatory factors,oxidative stress related indexes and endothelial function related indexes.(3)Short-term application of fasudil for CHD patients scheduled for elective PCI can have high safety.(4)Whether to use fasudil or not is one of the independent risk factors for the oCI-AKI occurrence in CHD patients after PCI. |
