目的: 证实降尿酸治疗对行冠脉介入术(PCI)的冠心病(CHD)伴无症状高尿酸血症患者肾功能有保护作用。方法: 将98例择期行介入术的冠心病伴无症状高尿酸血症患者,根据随机法分为对照组(50例)和观察组(48例)。对照组手术前后予以0.9 %NaCl溶液进行水化治疗,观察组除水化以外,于术前72 h开始口服苯溴马隆50 mg/d。比较两组患者手术前、术后12 h、术后72 h的血肌酐、血尿酸(UA)、血Cys-C、血NGAL、尿NGAL、尿NAG,同时对比造影剂肾病发生情况。结果: (1)对照组血Cys-C、血NGAL、尿NGAL、尿NAG术后12 h高于术前,血肌酐、血Cys-C、血NGAL术后72 h高于术前。观察组血UA术后两个时间点低于术前;(2)对照组术后12 h的血UA、血Cys-C、血NGAL、尿NGAL、尿NAG较观察组升高,对照组术后72 h的血UA、血Cys-C、血NGAL较观察组升高;(3)两组患者均无造影剂肾病发生。结论: 术前降尿酸治疗对冠心病伴无症状高尿酸血症患者PCI后肾功能有改善作用。
Objective: To confirm that urate-lowering therapy has a protective effect on renal function in patients with coronary heart disease (CHD) and asymptomatic hyperuricemia undergoing percutaneous coronary intervention (PCI). Methods: A total of 98 patients with coronary heart disease and asymptomatic hyperuricemia undergoing elective PCI were randomly grouped into control group (50 patients) and observation group (48 patients). The control group was hydrated with 0.9 % NaCl solution before and after surgery. In addition to hydration, the observation group started oral benzbromarone 50 mg/d 72 h before surgery. The serum creatinine, serum uric acid (UA), serum Cys-C, serum NGAL, urine NGAL and urine NAG before surgery, 12 h after surgery and 72 h after surgery were compared between the two groups, and the incidence of contrast-induced nephropathy was compared. Results: (1)In the control group, the levels of serum Cys-C, serum NGAL, urinary NGAL and urinary NAG at 12 h after surgery were higher than those before surgery, and the levels of serum creatinine, serum Cys-C and serum NGAL at 72 h after surgery were higher than those before surgery, while in the observation group, the levels of serum UA at two time points after surgery were lower than those before surgery; (2)The levels of serum UA, serum Cys-C, serum NGAL, urine NGAL and urine NAG at 12 h after surgery in the control group were higher than those in the observation group, and the levels of serum UA, serum Cys-C and serum NGAL at 72 h after surgery in the control group were higher than those in the observation group; (3) No contrast-induced nephropathy occurred in the two groups. Conclusion: Preoperative urate-lowering therapy can improve renal function in patients with coronary heart disease and asymptomatic hyperuricemia after PCI.
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