cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2459cardio-237Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESПрофилактика перипроцедурного повреждения почек нагрузочными дозами статинов при плановых чрескожных коронарных вмешательствахPrevention of periprocedural kidney ingury by loading doses of statins in elective percutaneous œronary interventionsВершининаЕ. О.VershininaE. O.noemail@neicon.ruРепинА. Н.RepinA. N.noemail@neicon.ruУдутВ. В.UdutV. V.noemail@neicon.ruТимофеевМ. С.TimofeevM. S.noemail@neicon.ruФГБНУ «Томский национальный исследовательский медицинский центр РАН», НИИ кардиологииРоссияTomsk National Research Medical Center of the Russian Academy of Science, Cardiology Research InstituteRussian FederationФГБНУ «Томский национальный исследовательский медицинский центр РАН», НИИФиРМ им. Е.Д. Гольдберга Томского НИМЦРоссияTomsk National Research Medical Center of the Russian Academy of Science, Goldberg Research Institute of Pharmacology and Regenerative MedicineRussian Federation201818112018585S2029Copyright © Kardiomag, 20182018KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/237

Цель исследования. Сравнить влияние нагрузочных доз аторвастатина (Ас) и розувастатина (Рс) на частоту острого перипроцедурного повреждения почек, а также выраженность острого воспалительного ответа на вмешательство при плановых чрескожных коронарных вмешательствах (ЧКВ). Материалы и методы. Проведено открытое проспективное сравнительное исследование, включившее 68 пациентов, направленных на плановое ЧКВ по поводу стенозирующего атеросклероза коронарных артерий. Исходно все пациенты длительно принимали статины в рамках стандартной гиполипидемической терапии. В 1-ю группу включено 33 пациента, получивших нагрузочную дозу Ас 80 мг за 12 часов до вмешательства с последующим сохранением этой дозы в течение 2-6 дней. Во 2-ю группу включено 35 больных, принимавших Рс 40 мг/сут. по той же схеме. Уровни креатинина (сКр) и цистатина С (ЦсС) в сыворотке крови определялись исходно, через 12, 24, 48 и 72 часа после вмешательства. Высокочувствительный С-реактивный белок (вчСРБ) измерялся исходно и через 72 часа после вмешательства. Результаты. Острое повреждение почек диагностировано у 5 (7,94%) пациентов: 4 (12,1%) пациента в группе Ас и 1 (3,3%) пациент в группе Рс (р=0,36). Уровень сКр у пациентов в группе Ас повысился на 43,4% больше, чем в группе Рс (р=0,024). Скорость клубочковой фильтрации снизилась на 15,5% больше в группе Ас по сравнению с группой Рс (р=0,09). Исходно уровень ЦсС в группах не различался (698,9 (560,2-869,6) нг/мл в группе Ас и 759,5 (673,8-899,9) нг/мл в группе Рс, р=0,75). Выявлены значимые межгрупповые различия в уровнях ЦсС в крови через 12 часов после ЧКВ (718,3 (555,6-839,6) нг/мл в группе Ас против 470,6 (378,2-689,4) нг/мл в группе Рс, р=0,007), сохранявшиеся и через 24 часа после вмешательства (732,1 (632,3-887) нг/мл и 526,4 (357,4-802,7) нг/мл соответственно, р=0,02). Со 2-х суток после ЧКВ межгрупповые различия уровней ЦсС в крови исчезли. Уровень вчСРБ достоверно повысился через 72 часа после вмешательства в группе Ас (1,65 (0,9-4) мг/л исходно в сравнении с 4,55 (1,6-8,7) мг/л через 72 часа, р=0,01). В этот же срок в группе Рс уровень вчСРБ значимо не изменился (2,8 (0,8-6,8) мг/л исходно, 2,75 (1,5-6,5) мг/л через 72 часа, р=0,16). Заключение. Нагрузочная доза розувастатина является более предпочтительной для профилактики перипроцедурного повреждения почек при ЧКВ и более значимо снижает общий воспалительный ответ на вмешательство по сравнению с нагрузочной дозой аторвастатина.

Purpose of the study. To compare the effect of loading doses of atorvastatin and rosuvastatin on the value of the acute kidney injury and acute inflammatory response to elective percutaneous coronary interventions. Materials and methods. An open prospective comparative study included 68 patients referred for elective percutaneous coronary intervention (PCI). At baseline, all patients had been taking statins for a long time as a standard lipid-lowering therapy. The first group included 33 patients who received a loading dose of 80 mg of atorvastatin (As) 12 hours before the intervention with saving this dose for 2-6 days. The second group included 35 patients treated with rosuvastatin (Rs) 40 mg/day in the same manner. The levels of creatinine and cystatin C in the blood were determined at baseline and 12, 24, 48 and 72 hours after the intervention. HsCRP level was determined at baseline and 72 hours after PCI. Results. AKI was diagnosed in 5 patients (7.94%): 4 patients (12.1%) in group As and 1 patient (3.3%) in group Rs (p = 0.36). The increase of serum creatinine level in the group As patients was 43.4% higher than one in the Rs group patients (p = 0.024). The decrease of glomerular filtration rate (GFR) in group As was 15.5% higher than one in group Rs (p = 0.09). Initially, the level of cystatin C in the groups did not differ (698.9 (560.2-869.6) ng/ml in group As vs 759.5 (673.8-899.9) ng/ml in group Rs, p = 0.75). Significant intergroup differences were found in the level of serum cystatin C 12 hours after PCI (718.3 (555.6-839.6) ng/ml in group As vs 470.6 (378.2-689.4) ng/ml in the Rs group, p = 0.007) that persisted 24 hours after the intervention (732.1 (632.3-887) ng/ml vs 526.4 (357.4-802.7) ng/ml, respectively, p = 0.02). From the second day after PCI, intergroup differences in serum cystatin C disappeared. The level of hsCRP significantly increased 72 hours after the intervention in group As (1.65 (0.9-4) mg/l at baseline vs 4.55 (1.6-8.7) mg/l 72 hours after PCI, p = 0.01). The level of hsCRP did not change significantly at the same time in the Rs group (2.8 (0.8-6.8) mg/l at baseline vs 2.75 (1.5-6.5) mg/l 72 hours after PCI, p = 0.16). Conclusion. The loading dose of rosuvastatin better prevents periprocedural kidney injury in PCI and more significantly reduces the overall inflammatory response to intervention compared to the loading dose of atorvastatin.

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The authors declare that there are no conflicts of interest present.