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Purpose: Contrast induced nephropathy (Contrast-induced nepropathy, CIN) is the application of iodinated contrast (Contrast media, CM) after major complications and hospital-acquired renal failure, the third largest common cause. Now widely recognized that chronic kidney disease (Chronic kidney disease, CKD) is the most important risk factor for CIN, other risk factors include diabetes (Diabetes mellitus, DM), CM dosage more and so on. Some retrospective studies and randomized controlled studies have found that coronary interventional continued use of perioperative statin drugs can reduce the incidence of CIN. The mechanism may be anti-inflammatory and anti-oxidant, and improve endothelial function. However, subsequent studies published on the short-term high-dose statins reduce the risk of CIN has not been consistent evidence of validity. These studies generally use a single serum creatinine (Serum creatinine, SCr) as the sole indicator of changes in renal function assessment, but neither directly nor SCr sensitive. Therefore, it is necessary to select a new more sensitive and specific markers to evaluate statins on glomerular and tubular function. This study enrolled DM with mild to moderate renal insufficiency (CKD2, 3 phase) in patients with high-dose explore whether rosuvastatin CM can reduce short-term effects on renal function and to explore new kidney injury markers serum cystatin C (Serum cystatin, SCysC), serum neutrophil gelatinase lipocalin (Neutrophil gelatinase-associated lipocalin, NGAL), urinary N-acetyl-β-D-glucosaminidase (Urinary N-acetyl-β-D -glucosaminidase, NAG) / urine creatinine (Urinary creatinine, Cr), and urinary albumin excretion rate (The ratio of concentrations of albumin to creatinine, ACR) and other evaluation of the feasibility and value of CIN. Methods: April 2009 to December 2009 a total of 120 cases in the General Hospital of Shenyang Military Region, Department of Cardiology, interventional treatment of hospitalized patients randomly assigned to rosuvastatin group and control group, 60 cases each. Rosuvastatin group was selected to start serving Dayton night rosuvastatin 10mg, at least two before surgery and continued until 3 days after application. Control group, the preoperative to postoperative 72 hours without taking any statin. Inclusion criteria: (a) Age 18-75 years old; (2) Type 2 DM; (3) CKD 2,3 of [hydration before estimated glomerular filtration rate (Estimated glomerular filtration rate, eGFR): 30 - 89ml/min/1.73m2]; (4) unstable angina; (5) at least 14 days without a statin, metformin, aminophylline, prostaglandin E1 and Guanxinsuhe balls containing aristolochic acid in medicine; (6) CM single dosage ≥ 150ml. Main exclusion criteria: (1) there is a statin or CM allergies; (2) type 1 DM, ketoacidosis or lactic acidosis; (3) New York Heart Association classification of cardiac function grade Ⅳ, hemodynamic instability ; (4) nearly 14 days used CM; (5) abnormal liver function, alanine aminotransferase gt; 2 times the upper limit of normal; (6) renal artery stenosis (unilateral stenosis> 70%, bilateral stenosis> 50%) . The study protocol was approved by the General Hospital of Shenyang Military Region Ethics Committee, and all patients signed informed consent prior to enrollment. CM iodixanol were applied. Outcomes included SCr, SCysC, NGAL, NAG / Cr, ACR change two definitions of CIN (gold standard: after 3 days of SCr increase ≥ 0.5mg/dl or elevated baseline ≥ 25%; SCysC baseline l High ≥ 25%) and 30-day incidence of clinical events. Results: Both baseline data match. Postoperative SCr, SCysC significantly higher (P <0.05), after the first two days peak, began to decrease after the first three days. Rosuvastatin group after the peak SCr was (113.1 ± 19.6) μmol / L, the peak of the control group (118.7 ± 23.1) μmol / L, the difference was not statistically significant. The rosuvastatin group were lower than the control group SCysC peak, respectively (0.96 ± 0.30) mg / L and (1.08 ± 0.34) mg / L (P = 0.043), and rosuvastatin group after the first 3 days SCysC reduced baseline levels, while the control group was still higher than the baseline. In SCysC elevated ≥ 25% from baseline evaluation of CIN was higher than the incidence of the gold standard, rosuvastatin group were 6.6% (4/60) and 3.3% (2/60, P = 0.003), control group were 11.7% (7/60) and 3.3% (2/60, P = 0.012). Compared with preoperative, postoperative NGAL increased (P <0.05), peak occurred after 2 hours, rosuvastatin group was significantly lower than the peak of the control group were (47.60 ± 18.72) μg / L and (62.19 ± 44.68) μg / L (P = 0.014). The control group on postoperative day 1 NAG / Cr increased, as (2.60 ± 1.48) U / mmol · Cr (P lt; 0.05), while the rosuvastatin group had no significant change in postoperative day 1 NAG / Cr is statistically significant. Postoperative day 3 ACR no significant change in preoperative ACR lt; 2.0mg/mmol · Cr ACR deterioration of patients (≥ 2.0mg/mmol · Cr) ratio was 9.4% (3/32) and 25.0% (9/36, P> 0.05). Rosuvastatin worsen the ACR relative risk reduction of 62.4%. Postoperative 30 days no clinical events. Conclusion: CM can cause a transient renal dysfunction, SCysC, NGAL, NAG, ACR early diagnosis of acute kidney injury is more sensitive than SCr. Large doses of rosuvastatin in preoperative ≥ 2 days to 3 days after CM administration may have caused alleviate DM with mild to moderate renal insufficiency reduced glomerular filtration rate and renal tubular injury.
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