作者：英硕1，陈嫱2，刘晓罡1，杨世诚1，李晓羽1，唐继超1，宫鑫成1，付涵3，赵智程3，张鹏1

单位：

1.300222天津市胸科医院心内科　2.300222天津市胸科医院呼吸与危重症医学科3.300070天津市，天津医科大学研究生院

Units：

1.Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China2.Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin 300222, China3.Graduate School of Tianjin Medical University, Tianjin 300070, China

关键词：

冠心病；肾病；造影剂；对比剂肾病；复方丹参滴丸；水化；经皮冠状动脉介入治疗

Keywords：

Coronary disease; Kidney system diseases (TCM) ; Contrast media; Contrast-induced nephropathy;Compound Danshen dropping pill; Hydration; Percutaneous coronary intervention

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.207

Funds：

天津市卫生健康委员会天津市中医药管理局中医中西医结合科研课题（2021205）

摘要：

目的　探讨复方丹参滴丸对冠心病患者经皮冠状动脉介入术（PCI）后对比剂肾病（CIN）的预防效果及作用机制。方法　选取2019—2021年于天津市胸科医院心内科接受PCI的冠心病患者641例为研究对象。根据治疗方法，将患者分为复方丹参滴丸联合水化组（n=320）和单纯水化组（n=321）。为减小偏倚，应用倾向性评分以1∶1的比例进行分组配对（卡钳值为0.01），最终共纳入398例患者，其中复方丹参滴丸联合水化组和单纯水化组各199例。复方丹参滴丸联合水化组采用复方丹参滴丸联合水化进行治疗，单纯水化组采用水化治疗。比较两组匹配前后基线资料，术前、术后48 h肾功能指标〔血清尿素氮、血清肌酐、估算肾小球滤过率（eGFR）、β2微球蛋白〕、超敏C反应蛋白（hs-CRP），术后CIN发生率。结果　匹配前，复方丹参滴丸联合水化组男性占比、贫血发生率高于单纯水化组，心肌梗死发生率低于单纯水化组（P ＜0.05）。匹配后，两组年龄、性别、BMI、糖尿病发生率、高血压发生率、心肌梗死发生率、心力衰竭发生率、贫血发生率、ACEI/ARB使用率、利尿剂使用率、TG升高者占比、LDL-C升高者占比、对比剂用量、水化量比较，差异无统计学意义（P ＞0.05）。复方丹参滴丸联合水化组术后血清尿素氮、血清肌酐、β2微球蛋白、hs-CRP低于单纯水化组，eGFR高于单纯水化组（P ＜0.05）。单纯水化组术后48 h血清肌酐、β2微球蛋白、hs-CRP高于术前，eGFR低于术前（P ＜0.05）；复方丹参滴丸联合水化组术后48 h血清尿素氮、eGFR低于术前，血清肌酐、β2微球蛋白、hs-CRP高于术前（P ＜0.05）。复方丹参滴丸联合水化组CIN发生率低于单纯水化组（P ＜0.05）。多因素Logistic回归分析结果显示，复方丹参滴丸联合水化〔OR =0.16，95%CI （0.05，0.53）〕、对比剂用量为150~299 ml〔OR =0.19，95%CI （0.07，0.52）〕是冠心病患者PCI后发生CIN的保护因素，BMI≥28.0 kg/m2〔OR =53.32，95%CI （9.23，307.92）〕、心肌梗死〔OR =8.61，95%CI （2.87，25.80）〕、心力衰竭〔OR =5.26，95%CI （1.83，15.08）〕是冠心病患者PCI后发生CIN的危险因素（P ＜0.05）。结论　复方丹参滴丸能有效降低冠心病患者PCI后CIN发生率，其机制可能与复方丹参滴丸通过抑制炎症反应来保护肾功能有关。

Abstract：

Objective　To investigate the preventive effect and mechanism of compound Danshen dripping pillson contrast-induced nephropathy (CIN) in patients with coronary heart disease after percutaneous coronary intervention (PCI) .Methods　A total of 641 patients with coronary heart disease who received PCI in the Department of Cardiology, Tianjin ChestHospital from 2019 to 2021 were selected as the research objects. According to the treatment method, the patients were divided intocompound Danshen dripping pills combined with hydration group (n=320) and simple hydration group (n=321) . In order to reducebias, the propensity score was used for grouping and matching at a ratio of 1∶1 (caliper value was 0.01) , and a total of 398 patientswere finally included, including 199 cases in the compound Danshen dropping pills combined with hydration group and 199 casesin the simple hydration group. The compound Danshen dripping pills combined with hydration group was treated with compoundDanshen dripping pills combined with hydration, and the simple hydration group was treated with hydration therapy. Baseline databefore and after matching, renal function indexes [serum urea nitrogen, serum creatinine, estimated glomerular filtration rate (eGFR) ,β2 microglobulin] , hypersensitive C-reactive protein (hs-CRP) before PCI and at 48 h after PCI, and the incidence of postoperativeCIN were compared between the two groups. Results　Before matching, the proportion of males and the incidence of anemia inthe compound Danshen dropping pills combined with hydration group were higher than those in the simple hydration group, andthe incidence of myocardial infarction was lower than that in the simple hydration group (P < 0.05) . After matching, there wereno statistically significant differences in age, gender, BMI, the incidences of diabetes, hypertension, myocardial infarction, heartfailure and anemia, the utilization ratios of ACEI/ARB and diuretics, the proportions of elevated TG and LDL-C, the dosagesof contrast agent, hydration between the two groups (P > 0.05) . The postoperative serum urea nitrogen, serum creatinine, β2microglobulin and hs-CRP in the compound Danshen dropping pills combined with hydration group were lower than those in thesimple hydration group, and the eGFR was higher than that in the simple hydration group (P < 0.05) . The serum creatinine, β2microglobulin and hs-CRP at 48 h after PCI in the simple hydration group were higher than those before PCI, and the eGFR waslower than that before PCI (P < 0.05) . In the compound Danshen dropping pill combined with hydration group, serum urea nitrogenand eGFR at 48 h after PCI were lower than those before PCI, while serum creatinine, β2 microglobulin and hs-CRP were higherthan those before PCI (P < 0.05) . The incidence of CIN in the compound Danshen dropping pills combined with hydration groupwas lower than that in the simple hydration group (P < 0.05) . The results of multivariate Logistic regression analysis showed thatcompound Danshen dripping pills combined with hydration [OR =0.16, 95%CI (0.05, 0.53) ] , 150-299 ml contrast agent [OR =0.19,95%CI (0.07, 0.52) ] were protective factors for CIN in patients with coronary heart disease after PCI, BMI ≥ 28.0 kg/m2 [OR =53.32,95%CI (9.23, 307.92) ] , myocardial infarction [OR =8.61, 95%CI (2.87, 25.80) ] and heart failure [OR =5.26, 95%CI (1.83,15.08) ] were risk factors for CIN in patients with coronary heart disease after PCI (P < 0.05) . Conclusion　Compound Danshendropping pills can effectively reduce the incidence of CIN in patients with coronary heart disease after PCI, and its mechanismmay be related to the protection of renal function by inhibiting inflammatory response.

ReferenceList：