长期服用ACEI/ARB对老年病人经冠脉介入术后肾功能的影响研究

doi:10.3969/j.issn.1003-9198.2022.12.013

摘要/Abstract

摘要： 目的观察老年病人长期服用血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB),对经皮冠脉介入(PCI)术后肾功能的影响。方法选择2020年1~6月在我院心内科住院的肾功能正常或轻度异常的并接受PCI治疗的老年病人共112例,分为观察组(服用ACEI/ARB)58例,对照组(未服用ACEI/ARB)54例,于术前完善血清肌酐(CRE)和肾小球滤过率(eGFR)检查,并于PCI术后24、48 h复查血清CRE和eGFR,对比术前与术后24、48 h CRE、eGFR的变化。结果 2组术后24、48 h CRE均较术前显著升高, eGFR较术前显著降低,观察组CRE升高水平显著低于对照组(P＜0.05),eGFR降低水平显著低于对照组(P＜0.05)。对照组发生造影剂肾病(CIN)1例(0.83%),观察组无CIN发生,2组CIN发生率差异无统计学意义(P=0.482)。结论老年病人长期服用ACEI/ARB能减轻对比剂对肾功能的影响,对CIN发生率的影响尚不确定。

关键词: 血管紧张素转化酶抑制剂, 血管紧张素受体拮抗剂, 肾功能, 经皮冠脉介入, 老年人

Abstract: Objective To observe the effects of long-term use of angiotensin-converting enzyme inhibitor (ACEI) or angiontensin receptor blocker(ARB) on the renal function in the elderly patients receiving percutaneous coronary intervention (PCI). Methods A total of 112 elderly patients with normal or mild abnormal renal function who underwent PCI were divided into observation group (using ACEI or ARB, n=58) and control group (not using ACEI or ARB, n=54). The serum level of creatinine(CRE) and glomerular filtration rate(eGFR) before or 24, 48 hours after PCI were detected and compared between the two groups. Results The level of CRE was significantly higher and the level of eGFR was significantly lower in both groups 24, 48 hours after PCI than that before PCI, especially in observation group (P<0.05). One patient(1.85%) presented with contrast-induced nephropathy (CIN) in control group. There was no statistical difference in the incidence rate of CIN between two goups (P=0.482). Conclusions In the elderly patients undergoing coronary intervention,long-term use of ACEI or ARB would reduce the effect of contrast medium on the renal function,but does not show a significant adverse effect on the incidence of CIN.

Key words: angiotensin-converting enzyme inhibitor, angiontensin receptor blocker, renal function, percutaneous coronary intervention, aged

中图分类号:

R541.4

朱京东, 徐彧, 陈群, 王立群. 长期服用ACEI/ARB对老年病人经冠脉介入术后肾功能的影响研究[J]. 实用老年医学, 2022, 36(12): 1238-1241.

ZHU Jing-dong, XU Yu, CHEN Qun, WANG Li-qun. Effect of long-term use of ACEI/ARB on the renal function in elderly patients receiving percutaneous coronary intervention[J]. Practical Geriatrics, 2022, 36(12): 1238-1241.

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