Atorvastatin combining with pr

1、Hindawi Publishing Corporatione Scientic World JournalClinicalStudyAtorvastatinCombiningwithProbucol:ANewWaytoReduceSerumUricAcidLevelduringPerioperativePeriodofInterventionalProcedureHongLi,1,2XimingLi,3HongjunMa,4YiranWang,3NaikuanFu,3DongxiaJin,3andHongliangCong3GraduateSchool,TianjinMedicalUnive

2、rsity,Tianjin300051,ChinaDepartmentofGeriatrics,TheFirstHospitalofQinhuangdao,Qinhuangdao066000,China3DepartmentofCardiology,TianjinChestHospital,TianjinMedicalUniversity,XianRoadNo.93,HepingDistrict,Tianjin,300051,China4CardiologyDepartment,DagangOilFieldGeneralHospital,TianjinMedicalUniversity,Tia

3、njin300051,China2Copyright©2014HongLietal.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.1.IntroductionContrastinducedacutekidneyinjury(CI-AKI)isreportedtobe

4、thethirdleadingcauseofin-hospitalacuterenalfailure13.Serumuricacid(SUA)couldstimulaterenin-angiotensin-aldosteronesystem4,whichplaysanimportantroleinthepathogenesisofCI-AKI.Hyperuricemiahaseverbeenconsideredasitsriskfactor5.Recently,researcheshaveshownthatatorvastatinandprobucolcouldimproveCI-AKIsep

5、arately68.However,littleisknownabouttheeffectofpretreatmentwithatorvastatincombinedwithprobucolonSUAlevelinpatientswhoexperiencecoronaryangiography(CAG)orpercutaneouscoronaryintervention(PCI).There-fore,inthisstudy,weinvestigatedtheeffectsofdifferentdosesofatorvastatincombinedwithfixeddoseofprobucol

6、onthelevelofSUAanditsroleinimprovingCI-AKI.2.MaterialandMethods2TheScientificWorldJournalTable1:Baselineclinical,biochemicalandproceduralcharacteristicsofthepatients.VariableAge(year)FemalegenderBodymassindex(kg/m2)Currentsmoking(𝑛)Totalcholesterol(mmol/L)Triglyceride(mmol/L)Low-densitylipop

7、rotein(mmol/L)Bloodglucose(mmol/L)Redbloodcellcount(1012/L)Whitebloodcellcount(109/L)Diabetesmellitus(𝑛)Volumeofcontrastagent(mL)Hypertension(𝑛)Valuesareexpressedasmeans±SDornumber(%)ofpatients.aByStudents𝑡test;bBy𝜒test.group(S-Cgroup,𝑛=55),intensivecombi

8、nedtreatmentgroup(I-Cgroup,𝑛=79),andintensiveatorvastatintherapygroup(I-Agroup,𝑛=74).ofTianjinChestHospitalofChina.Allpatientsprovidedwritteninformedconsent,andthestudywascarriedoutinaccordancewiththeDeclarationofHelsinki.3.ResultsTheScientificWorldJournalTable2:ComparisonofserumBUN,

9、Scr,SUAandeGFRlevelsatbaselineand24hoursafterIntervention.VariableBUN(mmol/L)BaselinePostproceduralAbsolutechangeBUN𝑃valueScr(umol/L)BaselinePostproceduralAbsolutechangeScr𝑃valueSUA(mmol/L)BaselinePostproceduralAbsolutechangeSUA𝑃valueeGFR(mL/min)BaselinePostprocedural𝑃

10、;value0.2030.0220.2870.1290.2890.0280.444𝑃valuewasthecomparisonofthegroupbetweenBaselineandPostprocedural.𝑃󸀠valuewasthecomparisonamonggroups.4.DiscussionIntravascularadministrationofiodinatedcontrastmediagivesrisetoapotentialdangerofrenalhemodynamicinstabilityasacauseofrenal

11、ischemia,hypoxia,andoxidativeinflammatoryresponse,thusbringingaboutimpairedrenalfunction15.RetrospectivestudieshavereportedCI-AKI4TheScientificWorldJournalTable3:Post-operationchangesofrenalparametersinthehypertensivesubgroup.VariableBUN(mmol/L)BaselinePostproceduralAbsolutechangeBUN𝑃valueSc

12、r(𝜇mol/L)BaselinePostproceduralAbsolutechangeScr𝑃valueSUA(mmol/L)BaselinePostproceduralAbsolutechangeSUA𝑃valueeGFR(mL/min)BaselinePostproceduralAbsolutechangeScr𝑃value0.0080.203𝑃valuewasthecomparisonofthegroupbetweenBaselineandPostprocedural.𝑃󸀠

13、;valuewasthecomparisonamonggroups.studiessuggestthathighlevelofSUAisanindependentriskfactorofhypertension26.HypertensivenephropathymayincreasethelevelofSUA.Hypertensioncomplicatedwithhyperuricemiacouldaffecteachother,resultinginrenalfunctiondamage.Theprophylacticeffectsofstatintreatmentonthedevel-op

14、mentofCI-AKIarestillcontroversial.Therecentsys-temicreviewandmeta-analysishavenotprovidedconclusiveresult27.Underthefixed-effectsmodel,anonsignificantprotectivetrendtowarddecreasedincidenceofCINwithperiproceduralshort-termhigh-dosestatintreatmentwasseen(RR:0.70;95%CI:0.481.02).Nevertheless,thereisag

15、reatbodyofstudiesthathaveprovedthatstatintreatmentcaneffectivelypreventCI-AKI28,29.InSuetal.sstudy30,multivariatelogisticregressionanalysisshowedthatpretreatmentwithhighdoseatorvastatinwasaprotectivefactorforpost-CI-AKI(20mgatorvastatin:𝑃=0.001;40mgatorvastatin:𝑃=0.001).Themechanismm

16、aybethatatorvastatincanimproveeGFR,removefreeradicals,inhibittheinflammatoryresponse31,32,andreduceuricacidlevelbyincreasingitsexcretion33.ProbucolplaysasignificantroleinimprovingtheCI-AKIowingtoclearingoxygenfreeradicals,againstoxidativestress,thusimprov-ingendothelialfunction8.Currently,thereisala

17、ckoflarge-scaleresearchesabouttheeffectonSUAofatorvas-tatincombinedwithprobucolintakeduringperioperativeintervention.Oursmallsampleresearchsuggestedthatacertaindoseofatorvastatinandprobucolintakeinshort-termpreoperativelycandecreasetheperioperativeSUAlevelsignificantly.TheBUNinI-Cgroupdecreased,whil

18、etherewasnosignificantdifferenceinScrandeGFR.TheSUAinI-Agroupdidnotdecrease,whiletheScrincreasedwithouteGFRdecreasing.TheanalysisofhypertensivesubgroupsuggestedthatintensiveatorvastatinandprobucolcombinationdidnotchangepostoperativeScrandeGFRsignificantly,butcouldreduceperioperativeSUAlevelsignifica

19、ntly.Accordingtoourstudy,combinationtreatmentofatorvastatinandprobucolbeforeinterventioncouldreduceperioperativeSUAlevel;furthertheintensivecombinedtreatmentcanimproveCI-AKI.Forhypertensivepatients,combinationandintensivetreatmentcouldreduceSUAlevelandimprovetheCI-AKI.Thus,patientswithcoronaryheartd

20、iseaseorhypertensionwhoareundergoingtheinterventionmaybenefitfromthecombinedmedicationbyreducingtheuricacidlevelandimprovingCI-AKI.Themajorlimitationsofthepresentstudyweretheshortdurationofobservationandhavingasmallsample.Also,thiswasasingle-centerobservationalclinicalstudy.Largesampleandmulticenter

21、trialsoughttobedesignedtoverifytheconclusion.ConflictofInterestsTheauthorshavenocompetinginterests.AuthorsContributionHongLiandXimingLiareco-firstauthorsforthispaper.TheScientificWorldJournalAcknowledgmentsThispaperwassupportedbyagrantfromTianjinScienceandTechnologySupportPlanKeyProject(12ZCZDSY0320

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