关键词: 冠心病, 高尿酸血症, 非布司他, 造影剂肾病, 影响因素分析

Abstract: Background　The morbidity and mortality of coronary heart disease（CHD） are increasing year by year.More than 1 million people die from CHD every year.Wide application of percutaneous coronary intervention（PCI） for CHD brings about an incidence of contrast-induced nephropathy （CIN） of 2%-30%，which increases the financial burden of patients and society，and affects the prognosis of such patients.Studies have found that there is a close relationship between serum uric acid（sUA） and CIN，and elevated sUA can increase the risk of CIN.Objective　To investigate the preventive effect of uric acid lowering therapy on CIN in patients with CHD complicated with hyperuricemia.Methods　A total of 100 cases of CHD with hyperuricemia receiving PCI treatment were selected from Department of Cardiovascular，the Second Affiliated Hospital of Zhengzhou University from January 2017 to January 2018，and were randomly and evenly divided into experimental group and control group.Both groups received coronary angiography or coronary stent implantation with secondary prevention therapies for CHD，the difference was that the experimental group took oral febuxostat 40 mg 24 hours and immediately before the surgery，while the control group did not take any drugs for lowering uric acid.Levels of serum creatinine（Scr），sUA and serum cystatin C（Cys-C） measured at 48 hours before surgery and 72 hours after surgery，and the incidence of CIN of both groups were collected and compared.Results　The average sUA and Cys-C levels were much lower in the experimental group（P<0.05），while average Scr was similar in both groups at 72 hours after surgery（P>0.05）．Compared with baseline，the average Scr and Cys-C levels at 72 hours after surgery changed insignificantly in the experimental group（P>0.05），but average sUA level decreased（P<0.05）；in the control group，average Scr and sUA levels had little changes（P>0.05），but Cys-C level increased significantly（P<0.05）．The incidence of CIN was 18.0% （9/50） in the experimental group，and 22.0% （11/50） in the control group，showing no significant intergroup difference （χ2=0.250，P=0.617）．Multivariate Logistic regression analysis showed that age 〔OR=1.362，95%CI（1.030，1.802） 〕，LDL-C〔OR=1.988，95%CI（1.239，3.190）〕，contrast agent dosage 〔OR=1.426，95%CI（1.097，1.853） 〕，Cys-C at 72 hours after surgery〔OR=3.374，95%CI（2.482，4.581）〕were all factors associated with CIN （P<0.05）．Conclusion　Although preoperative uric acid lowering treatment could not reduce incidence of CIN，it could inhibit the increase of postoperative Cys-C level.However，its long-term effect on postoperative renal function still needs to be examined by large-scale clinical trials.

Key words: Coronary disease, Hyperuricemia, Febuxostat, Contrast induced nephropathy, Root cause analysis