| Background and ObjectiveContrast-induced nephropathy(CIN)is the acute renal dysfunction caused by contrast medium(CM)during the application of CM.With the widespread using of contrast medium in medical imaging and interventional therapy,CIN has became one of the three common causes of iatrogenic acute kidney injury.In all medical procedures that using contrast medium for diagnosis or treatment,the incidence of CIN induced by percutaneous coronary intervention(PCI)is the highest,accounting for almost half of the total number of CIN incidence.CIN not only prolongs the length of hospital stays and increases medical costs of patients,but also increases the incidence of in-hospital dialysis,short-term mortality and long-term mortality.Once CIN occurs,there is no effective treatment strategy,so early prevention of CIN is extremely important.According to reports,the incidence of CIN after PCI in patients with normal renal function is <3%,while the incidence of CIN after PCI in patients with chronic renal insufficiency can be as high as 40%.So the prevention of CIN in patients with chronic renal failure who underwent PCI has became a topic of particular concern for many cardiovascular clinicians.The pathogenesis of CIN is unclear,and the currently proposed theories mainly include:(1)contrast medium can cause renal vasoconstriction and lead to renal ischemia and hypoxia.(2)Renal ischemia and hypoxia cause an increase in reactive oxygen species(ROS),which cause oxidative stress damage to the kidney.(3)The direct cytotoxicity of contrast medium can induce apoptosis and necrosis of renal tubular epithelial cells.To prevent the occurrence of CIN,researchers have conducted a large number of clinical trials of potentially valuable drugs based on the currently proposed pathogenesis.Statins have attracted researchers’ attention due to their effects of increasing nitric oxide,reducing endothelin secretion,anti-oxidation,anti-inflammatory and anti-apoptosis,and a large number of randomized controlled trials have shown that statins can effectively reduce the risk of CIN.Similarly,coenzyme Q10(Co Q10)also has powerful effect of antioxidant,scavenging ROS,and anti-inflammatory cytokine.However,many studies have shown that statins can prevent the endogenous synthesis and exogenous absorption of Co Q10,so that reduce Co Q10 in plasma by 16-54%.Previous studies have shown that the application of Co Q10 on the basis of statins can show a stronger effect of anti-oxidative stress,improving endothelial function and reduceing ischemia-reperfusion injury.Therefore,Co Q10 combined with statins may further reduce the renal damage caused by contrast medium.However,there is no related study at home and abroad to compare the effect of Co Q10 combined with statins and statins alone in preventing CIN.This study intends to compare the protective effect of Co Q10 combined with atorvastatin and atorvastatin alone on renal functions of patients with chronic renal insufficiency after PCI,in order to evaluate whether the effect of Co Q10 combined with atorvastatin on preventing CIN was better than that of atorvastatin alone,so as to provide new evidence for clinical drug prevention of CIN..MethodAccording to the inclusion and exclusion criteria,a total of 119 hospitalized patients with chronic renal insufficiency(estimated glomerulare filtration rate,e GFR=30-89 m L/min/1.73m2)who underwent elective PCI were included in this study.Patients in this study were divided into the atorvastatin group(control group,n=59)and the Co Q10 combined with atorvastatin group(trial group,n=60)by the random number table method.The trial group started to take atorvastatin calcium tablet 20 mg at 48 hours before PCI(once/night,long-term use after PCI);the trial group began to take atorvastatin calcium tablets 20 mg at 48 hours before PCI(once/night,long-term use after PCI)and Co Q10 capsules 20 mg at 48 hours before PCI(3 times / day,up to 3 days after PCI).Both two groups of patients received intravenous saline infusion at a rate of 1 ml / kg / h or 0.5ml / kg / h(for patients with LVEF<45%)at least 6 hours before PCI and 12 hours after PCI.The Serum creatinine(Scr)values and e GFR values at 48 hours before PCI,48 hours after PCI and 72 hours after PCI,and Cystatin C(Cys-C)values at 48 hours before PCI and 48 hours after PCI were compared between the two groups.The incidence of CIN was compared between the two groups(CIN is defined as an increase in Scr level of 44 mol/L(0.5mg/dl)or more than 25% above baseline in the 48 hours to 72 hours of using CM);The major adverse cardiovascular events and adverse drug reactions during the hospitalization were recorded..Result1.There was no statistical difference in the general clinical data,perioperative medication,the amuont of contrast medium consumed,and biochemical indicators between the two groups of patients before PCI(P>0.05).2.There were no statistically significant differences in Scr,e GFR or Cys-C between the two groups at baseline(48 hours before PCI)(P>0.05).The Scr values of the trial group at 48 hours and 72 hours after PCI were significantly lower than those in the control group(P<0.05).The e GFR values of the trial group at 48 hours and 72 hours after PCI were significantly higher than those in the control group(P<0.05),and the Cys-C level of the trial group at 48 hours after PCI was significantly lower than the level of the control group(P<0.05).3.Compared with baseline,the Scr value and Cys-C value were significantly increased and the e GFR value was significantly decreased at 48 hours after PCI in both groups(P<0.05);Compared with the baseline,the Scr value of the control group was still significantly increased and the e GFR value of the control group was still significantly decreased at 72 hours after the PCI(P<0.05),while the Scr value and e GFR value of the trial group were both recovered to the baseline levels at 72 hours after PCI(P>0.05).4.A total of 12 persons in the control group developed CIN,with an incidence rate of 20.34%.A total of 4 persons in the trial group developed CIN,with an incidence rate of 6.67%.The incidence of CIN in the trial group was significantly lower than that in the control group(P<0.05).5.Multivariate stepwise backward logistic regression analysis showed that Co Q10 was an independent protective factor for CIN after PCI in patients with chronic renal insufficiency.Diabetes history,contrast volume(CV)/e GFR ≥ 3,and male are risk factors for CIN after PCI in patients with chronic renal insufficiency(P?<0.05).6.In the diabetic subgroup,the incidence of CIN in the control group was 38.10%,while that in the trial group was 8.70%.The incidence of CIN in the trial group was significantly lower than that in the control group(P<0.05).Conclusions1.Compared with atorvastatin alone,Co Q10 combined with atorvastatin can safely and effectively reduce the incidence of CIN after PCI in patients with chronic renal insufficiency.2.In patients with chronic renal insufficiency and diabetes,the effect of Co Q10 combined with atorvastatin in the prevention of CIN after PCI is better than that of atorvastatin alone.3.Co Q10 is an independent protective factor for CIN after PCI in patients with chronic renal insufficiency.Diabetes,CV/e GFR ≥ 3,and male are risk factors for CIN after PCI in patients with chronic renal insufficiency. |
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