ACEI/ARB与CCB防治高血压病伴慢性肾功能不全患者发生造影剂肾病的效果比较

陈彩玲; 黄 铮; 赖雯苑; 滕树恩; 洪承路; 赵新军

ACEI/ARB与CCB防治高血压病伴慢性肾功能不全患者发生造影剂肾病的效果比较

Comparative study on effect of ACEI/ARBs and CCBs in prevention of contrast-induced nephropathy in patients with hypertension associated with chronic renal insufficiency after coronary artery intervention

摘要

摘要: 目的比较血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻断剂(ARB)和钙离子通道阻断剂(CCB)对高血压病伴慢性肾功能不全（CKD）患者在介入术后发生造影剂肾病(CIN)的防治效果。方法回顾分析近6年南方医院内科病房180例高血压病伴CKD 2~3期患者，所有患者均接受了冠脉介入术，并在术前术后使用了水化治疗，术前至少使用了7 d的ACEI/ARB或CCB药物，另设单纯水化对照组；观察3组患者发生CIN的例数，以及术后24、48、72 h及 7d的血清肌酐（SCr）、肌酐清除率（CCr）的变化水平，并记录肾功能恢复的时间。结果 ACEI/ARB组术后发生CIN 20例（占37%)，CCB组术后发生CIN 16例（占20%)，单纯水化组发生28例(占61%)；与单纯水化组比较，两组术后CIN发生率均较低（P<0.05，P<0.01）；CCB组和ACEI/ARB组比较，CCB组的CIN发生率较低（P<0.05）。3组患者介入术后24、48、72 h及7 d的SCr、CCr水平均有明显升高，差异有显著性；与单纯水化组相比，ACEI/ARB组和CCB组的血清SCr、CCr水平在24、48、72 h及7 d的时间点均有所降低，差异有显著性；CCB组与ACEI/ARB组相比，48、72 h及7 d的SCr降低较明显（均P<0.05）。术后14 d，ACEI/ARB组有14例（占70%）CIN患者肾功能恢复至术前水平，CCB组有12例（占75%），单纯水化组有16例（占62%），ACEI/ARB组和CCB比较差异无统计学意义。结论使用ACEI/ARB 和CCB类药物均可对高血压病并发CKD患者发生CIN有预防作用；CCB类药物优于ACEI/ARB类药物。

Abstract: AIM To evaluate the efficacy of ACEI/ARBs and CCBs in prevention of contrast-induced nephropathy (CIN) in patients with hypertension associated with chronic renal insufficiency after coronary artery intervention. METHODS We retrospectively analyzed 180 patients with 2-3 phase chronic kidney diseases (CKD) in our hospital. Patients all underwent coronary angioplasty and hydration therapy and were taking ACEI/ARBs drugs or CCBs drugs for at least 7 days prior to surgery. The control group was treated only with hydration. The number of patients who developed CIN in the three groups was compared and the level of serum creatinine (SCr) and creatinine clearance rate (CCr) 24, 48, 72 h and 7 days after coronary angioplasty were recorded. RESULTS CIN occurred in 37% of the patients (20/54) in ACEI/ARBs group, in 20% of the patients (16/80) in CCBs group and 56.5% of the patients (28/46) in hydration control group. Compared with the hydration group, CIN incidence decreased obviously in ACEI/ARBs group and CCBs group after coronary angioplasty (P<0.05, P<0.01). Incidence of CIN in CCBs group was lower than that in ACEI/ARBs group (P<0.05). Compared with preoperative levels, levels of plasma creatinine (SCr) and endogenous creatinine clearance rate (Ccr) significantly increased 24, 48, 72 h and 7 days after surgery in all three groups with significant differences. Compared with hydration control group, levels of plasma SCr and Ccr significantly decreased 24, 48, 72 h and 7 days after surgery in ACEI/ARBs group and CCBs group, with significant differences. Compared with that in ACEI/ARBs group, the SCr level 48, 72 h and 7 days after the surgery in CCBs group was lower (P<0.05). Renal functions recovered to pre-operative levels in 70% of the patients in ACEI/ARBs group at 14 days after operation, in 75% in CCBs group and in 61.5% in hydration group, with no statistical difference between ACEI/ARBs group and CCBs group. CONCLUSION ACEI/ARBs and CCBs drugs are beneficial for the prevention of CIN in patients with chronic renal failure. CCB drugs may be more effective than ACEI/ARB drugs for better prevention of CIN and shorter recovery time in patients with chronic renal failure.

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