The Effect Of Intravenous Administration Nicorandil On Renal Function In ACS Patients With Diabetes After PCI

Objective:To investigate the effect of intravenous administration nicorandil on renal function in acute coronary syndrome patients with diabetes after percutaneous coronary intervention and its possible mechanism.Methods:From January 2018 to October 2018,acute coronary syndrome patients with type 2diabetes mellitus were errolled into this study.All patients were treated with PCI.The population was randomly divided into control group and observation group.Control group:conventional treatment+hydration treatment;Observation group:conventional treatment+hydration treatment+intravenous administration nicorandil?0.1mg/?kg·h?5h before PCI to24h after PCI?.The gender,age,height,weight,blood pressure,blood lipid,liver function,myocardial enzyme,fasting blood glucose and glycosylated hemoglobin of all the selected patients were collected and recorded in detail.The amount of intraprocedural contrast agent,the number of stents implanted and the application of bivalirudin and tirofiban were recorded during intraprocedural and postprocedural.Renal function indexes were observed respectively:BUN,SCr,?₂-MG,CysC,eGFR 24h before PCI and 6h,24h,48h,72h after PCI.Inflammatory indexes were observed respectively:hs-CRP,SAA and NLR 24h before and after PCI,and NT-ProBNP was mearured as the cardiac function index.Results:A total of 85 patients were enrolled in this control experiment,including 48 males and 37females.The control group included 43 patients?23 males and 20 females,with an average age of 59.95±8.40 years?,and the observation group included 42 patients?25 males and 17females,with an average age of 59.43±8.60 years?.1.Based data comparison:The basic data of admission of the two groups?age,height,weight,blood pressure,blood lipid,hepatic function,myocardial enzyme,fasting glucose,glycosylated hemoglobin?were not statisticaly different,P>0.05.Enumeration data:gender,hypertension,diabetes,history of drinking,smoking and basic medication,including aspirin,tigreglio,clopidogrel,low molecular weight heparin,statins,beta receptor blockers,nitrates,ACEI/ARB were tested by chi-square test,P>0.05,there were not statistical difference.2.Changes of renal function indexes before and after PCI in two groups:The baseline BUN,SCr,?₂-MG,CysC and eGFR in two groups were within the normal range without statistical difference?P>0.05?.The SCr level in the observation group was significantly lower than that in the control group?70.62±21.54?mol/L vs 82.3±26.71?mol/L?at 48h after PCI.The levels of?₂-MG and CysC in the observation group at 48h and 72h after PCI were significantly lower than those in the control group??₂-MG:2.11±0.80mg/L vs 2.54±0.48mg/L,2.01±0.80mg/L vs 2.42±0.61mg/L;CysC:1.06±0.28mg/L vs 1.42±0.39mg/L,0.96±0.25mg/L vs 1.07±0.25mg/L?,there were statistically difference?P<0.05?.The eGFR in the observation group at 48h and 72h after PCI was significantly higher than that in the control group[99.14±27.09mL/?min·1.73m²?vs 86.02±23.26mL/?min·1.73m²?,100.68±26.62mL/?min·1.73m²?vs 89.28±24.69mL/?min·1.73m²?],?P<0.05?.3.Changes of inflammatory index and NT-ProBNP level before and after PCI in two groups:The baseline hs-CRP,SAA,NLR and NT-ProBNP levels in two groups were within the normal range,there were not significantly difference?P>0.05?.The level of hs-CRP,SAA,NLR and NT-ProBNP in the observation group were obviously lower than those in control group at 24h after PCI?hs-CRP:13.86±2.22mg/L vs 19.59±3.17mg/L;SAA:11.11±1.85ug/L vs 14.39±2.33ug/L;NLR:3.05±0.53%vs 4.06±0.62%;NT-ProBNP:322.25±43.74pg/mL vs609.23±70.91pg/mL?,?P<0.05?.4.Comparison of CIN incidence between the two groups:There were 2 cases of CIN in observation group and 5 cases in control group.Compared with the control group,the incidence of CIN in observation group was less than that in control group?4.8%vs 11.9%?,but the difference between two groups was not statistically significant?P>0.05?.Conclusion:1.Intravenous administration nicorandil has a protective effect on renal function in ACS patients with diabetes after percutaneous coronary intervention,but it cannot reduce the incidence of CIN.2.The possible mechanism is to inhibit inflammatory response,reduce oxidative stress,increase renal perfusion.