复方丹参滴丸联合他汀类药物防治冠心病患者PCI术后并发造影剂肾病的疗效及对血管功能的影响

吴农田 徐兰芹

〔摘要〕 目的 探討复方丹参滴丸联合他汀类药物防治冠心病（CHD）患者经皮冠状动脉介入治疗（PCI）术后并发造影剂肾病（CIN）的效果及对血管功能的影响。方法 按随机数字表法将行PCI术的194例CHD患者分成联合组和对照组各97例。对照组予以水化+阿托伐他汀方案，联合组在对照组基础上联合复方丹参滴丸口服方案。观察比较两组患者手术前后肾功能损害指标[血清肌酐（SCr）、细胞间黏附分子-1（ICAM-1）、内生肌酐清除率（Ccr）]、血管内皮功能[内皮素（ET）、肱动脉血管内皮依赖性舒张功能（FMD）]、炎症因子[白细胞介素-6（IL-6）、白细胞介素-8（IL-8）]检测结果变化情况，比较其CIN发生率差异。结果 两组患者术后血清SCr、ICAM-1水平均较术前明显提高（P<0.01），但联合组低于对照组（P<0.05）；CCr水平则较术前明显降低（P<0.01），但联合组高于对照组（P<0.05）。两组患者术后血清ET、IL-6、IL-8水平均较术前明显降低（P<0.01），且联合组低于对照组（P<0.05）；FMD水平则较术前明显提高（P<0.01），且联合组高于对照组（P<0.05）。联合组CIN发生率明显低于对照组（P<0.05）。结论 复方丹参滴丸联合阿托伐他汀能有效降低CHD患者PCI术后CIN发生风险，对减轻其肾脏损害程度、改善血管内皮功能具有积极意义。

〔关键词〕 冠心病；PCI；复方丹参滴丸；他汀类药物；造影剂肾病；血管功能

〔中图分类号〕R256.2；R541.4 〔文献标志码〕B 〔文章编号〕doi：10.3969/j.issn.1674-070X.2018.03.025

Effects of Compound Danshen Dripping Pills Combined with Statins on Preventing Contrast-Induced Nephropathy in Patients with Coronary Heart Disease after PCI and its Influence on Vascular Function and Inflammatory State

WU Nongtian， XU Lanqin

（Cardiovascular Department， the Second Hospital of Weinan， Weinan， Shaanxi 714000， China）

〔Abstract〕 Objective To investigate the effects of compound Danshen dripping pills combined with statins in prevention and treatment of contrast induced nephropathy （CIN） in patients with coronary heart disease （CHD） after percutaneous coronary intervention （PCI） and the effect on vascular function. Methods 194 cases of patients with CHD treated by PCI were divided into the combined group and the control group by random number table method， 97 cases in each group. The control group were treated with hydration and atorvastatin， and the combined group were treated with compound Danshen dripping pills， on the basis of treatment in the control group. The changes of indexes of renal function damage [serum creatinine （SCr）， intercellular adhesion molecule-1 （ICAM-1）， creatinine clearance rate （Ccr）]， vascular endothelial function [endothelin （ET）， brachial artery endothelial dependent diastolic function （FMD）] and inflammatory factors [interleukin-6 （IL-6）， interleukin-8 （IL-8）] before and after treatment were compared between the two groups， and the difference in the incidence of CIN was recorded. Results After operation， levels of serum SCr and ICAM-1 in the two groups increased significantly （P<0.01）， and the levels in the combined group were lower than the control group （P<0.05）. After operation， CCr level significantly decreased， and the level in the combined group was higher than the control group （P<0.05）. After operation， levels of serum ET， IL-6 and IL-8 in the two groups significantly decreased （P<0.01）， and the levels in combined group were lower than the control group （P<0.05）. After operation， FMD levels increased significantly （P<0.01）， and the levels in the combined group were higher than the control group （P<0.05）. The incidence of CIN in the combined group was significantly lower than that in the control group （P<0.05）. Conclusion Compound Danshen dripping pills combined with atorvastatin could effectively reduce the risk of CIN in patients with CHD after PCI， which is of positive significance in reducing the degree of renal damage and improving the vascular endothelial function.

〔Keywords〕 coronary heart disease； PCI； compound Danshen dripping pills； statins； contrast medium nephropathy； vascular function

随着生活节奏的加快及生活结构的改变，心血管疾病已成为威胁现代人生命健康安全的常见病而受到广泛关注，如何有效改善冠心病（CHD）等心血管疾病患者的预后效果也成为各学者探究的热点。由于CHD患者以中老年人为主要患病群体，常合并“三高”等肾血管致病因素，经皮冠状动脉介入治疗（PCI）时使用的大剂量造影剂可增加其术后造影剂肾病（CIN）发生风险[1]，于其预后恢复不利。复方丹参滴丸是一种兼具活血化瘀、行气止痛功效的纯中药制剂，CHD患者用药后能改善血液微循环状态，对减轻炎症反应、应激反应程度，保护缺血、缺氧细胞功能等有利[2]。临床研究发现复方丹参滴丸中的丹参、三七等中药材有一定肾损伤缓解作用[3]，可能对预防CIN的发生有一定价值。……