تأثير رزوواستاتين در پيش گيري از آسيب حاد كليه ي ناشي از ماده ي حاجب در بيماران مبتلا به بيماري مزمن كليه

The Effect of Rosuvastatin on Prevention of Contrast-Induced Acute Kidney Injury in Patients with Chronic Kidney Disease

ﻣﻘﺪﻣﻪ: CI-AKI) Contrast-induced acute kidney injury(، آﺳﯿﺐ ﺣﺎد ﮐﻠﯿﻮي ﻧﺎﺷﯽ از درﯾﺎﻓﺖ ﻣﺎده ي ﺣﺎﺟﺐ اﺳﺖ ﮐﻪ ﯾﮑﯽ از ﻣﺸﮑﻼت ﻣﻬﻢ درﯾﺎﻓﺖ ﮐﻨﻨﺪﮔﺎن ﻣﺎده ي ﺣﺎﺟﺐ ﺑﻪ دﻧﺒﺎل اﻧﺠﺎم روش ﻫﺎي ﺗﺸﺨﯿﺼﯽ و درﻣﺎﻧﯽ ﺗﺼﻮﯾﺮﺑﺮداري ﻣﯽ ﺑﺎﺷﺪ. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ﺑﻪ ﺑﺮرﺳﯽ ﺗﺄﺛﯿﺮ رزوواﺳﺘﺎﺗﯿﻦ در ﭘﯿﺶ ﮔﯿﺮي از آﺳﯿﺐ ﺣﺎد ﮐﻠﯿﻪ ي ﻧﺎﺷﯽ از ﻣﺎده ي ﺣﺎﺟﺐ در ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺑﯿﻤﺎري ﻣﺰﻣﻦ ﮐﻠﯿﻪ ﺑﻪ دﻧﺒﺎل ﺳﯽ ﺗﯽ اﺳﮑﻦ ﺗﺸﺨﯿﺼﯽ ﭘﺮداﺧﺘﻪ ﺷﺪ. روش ﻫﺎ: اﯾﻦ ﻣﻄﺎﻟﻌﻪ ي ﮐﺎرآزﻣﺎﯾﯽ ﺑﺎﻟﯿﻨﯽ، روي 402 ﻧﻔﺮ از ﺑﯿﻤﺎران داراي ﺑﯿﻤﺎري ﻣﺰﻣﻦ ﮐﻠﯿﻪ ﮐﻪ ﺳﯽ ﺗﯽ اﺳﮑﻦ ﺑﺎ ﻣﺎده ي ﺣﺎﺟﺐ در ﺑﯿﻤﺎرﺳﺘﺎن اﻟﺰﻫﺮاي )س( اﺻﻔﻬﺎن در ﺳﺎل 1397 اﻧﺠﺎم ﺷﺪ. ﺑﯿﻤﺎران ﺑﻪ دو ﮔﺮوه ﺗﻘﺴﯿﻢ ﺷﺪﻧﺪ. ﺑﯿﻤﺎران ﮔﺮوه ﻣﻮرد، 20 ﻣﯿﻠﯽ ﮔﺮم رزوواﺳﺘﺎﺗﯿﻦ در 24 ﺳﺎﻋﺖ ﻗﺒﻞ از ﺳﯽ ﺗﯽ اﺳﮑﻦ و ﺗﺎ دو روز ﺑﻌﺪ، روزاﻧﻪ 10 ﻣﯿﻠﯽ ﮔﺮم ﻗﺮص رزوواﺳﺘﺎﺗﯿﻦ درﯾﺎﻓﺖ ﮐﺮدﻧﺪ. ﺑﯿﻤﺎران ﮔﺮوه ﺷﺎﻫﺪ، ﺗﻨﻬﺎ داروﻧﻤﺎ درﯾﺎﻓﺖ ﮐﺮدﻧﺪ. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ﻣﯿﺰان ﺗﻐﯿﯿﺮات ﮐﺮاﺗﯿﻨﯿﻦ، ﺗﻐﯿﯿﺮات ﻓﯿﻠﺘﺮاﺳﯿﻮن ﮔﻠﻮﻣﺮوﻟﯽ و ﻣﯿﺰان ﺑﺮوز ﻧﻔﺮوﭘﺎﺗﯽ ﻣﻮرد ﺑﺮرﺳﯽ ﻗﺮار ﮔﺮﻓﺖ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﺑﯿﻦ دو ﮔﺮوه ﻣﻮرد ﻣﻄﺎﻟﻌﻪ، اﺧﺘﻼف ﻣﻌﻨﯽ داري ﺑﺮ اﺳﺎس ﮐﺮاﺗﯿﻨﯿﻦ و ﻓﯿﻠﺘﺮاﺳﯿﻮن ﮔﻠﻮﻣﺮوﻟﯽ ﺑﻌﺪ از ﺳﯽ ﺗﯽ اﺳﮑﻦ وﺟﻮد داﺷﺖ )0/050 < P(؛ ﺑﻪ ﻃﻮري ﮐﻪ ﻣﯿﺎﻧﮕﯿﻦ ﮐﺮاﺗﯿﻨﯿﻦ در ﺑﯿﻤﺎران ﮔﺮوه ﻣﻮرد ﺑﻌﺪ از ﻣﺪاﺧﻠﻪ ﺑﻪ ﺻﻮرت ﻣﻌﻨﯽ داري ﮐﻤﺘﺮ از ﮔﺮوه ﺷﺎﻫﺪ ﺑﻮد و از ﻃﺮﻓﯽ، ﻣﯿﺎﻧﮕﯿﻦ ﻓﯿﻠﺘﺮاﺳﯿﻮن ﮔﻠﻮﻣﺮوﻟﯽ در ﮔﺮوه ﻣﻮرد، ﺑﻪ ﺻﻮرت ﻣﻌﻨﯽ داري ﺑﯿﺸﺘﺮ از ﮔﺮوه ﺷﺎﻫﺪ ﺑﻮد )0/050 < P(. ﻫﻤﭽﻨﯿﻦ، ﻣﯿﺰان ﻓﺮاواﻧﯽ ﻧﻔﺮوﭘﺎﺗﯽ در ﮔﺮوه ﻣﻮرد1 درﺻﺪ و در ﮔﺮوه ﺷﺎﻫﺪ 4 درﺻﺪ ﺑﻮد )0/059 = P(. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: اﺳﺘﻔﺎده از رزوواﺳﺘﺎﺗﯿﻦ، ﻣﯽ ﺗﻮاﻧﺪ ﺧﻄﺮ آﺳﯿﺐ ﮐﻠﯿﻮي ﺷﺎﻣﻞ اﯾﺠﺎد ﻧﻔﺮوﭘﺎﺗﯽ، اﻓﺰاﯾﺶ ﮐﺮاﺗﯿﻨﯿﻦ و ﮐﺎﻫﺶ ﻓﯿﻠﺘﺮاﺳﯿﻮن ﮔﻠﻮﻣﺮوﻟﯽ در ﺑﯿﻤﺎران داراي ﺑﯿﻤﺎري ﻣﺰﻣﻦ ﮐﻠﯿﻮي ﺑﻪ دﻧﺒﺎل ﺳﯽ ﺗﯽ اﺳﮑﻦ ﺑﺎ ﻣﺎده ي ﺣﺎﺟﺐ را ﮐﺎﻫﺶ دﻫﺪ.

Background: Contrast-induced acute kidney injury (CI-AKI) is an important issue in patients who are candidate for using contrast media in order to do diagnostic and therapeutic imagining. This study aimed to investigate the effect of rosuvastatin on the development of contrast-induced acute kidney injury in patients with chronic kidney disease performing computed tomography (CT) scan with contrast media. Methods: In this clinical trial study, 402 patients with chronic kidney disease who underwent CT scan with contrast in Alzahra hospital, Isfahan, Iran, during the years 2018-2019 were studied. Patients were divided into two groups, patients in the first group received 20 mg rosuvastatin 24 hours prior to CT scan and 10 mg rosuvastatin tablets daily for two consecutive days. The second group received the placebo. Findings: There was a significant difference in creatinine and glomerular filtration rate (eGFR) after CT scan (P < 0.050). The mean of creatinine was lower, and the mean of eGFR was higher in the intervention group than placebo after the intervention (P < 0.050). The frequency of contrast-induced acute kidney injury in the intervention group was 1%, and in the placebo group was 4% (P = 0.059). Conclusion: Rosuvastatin can reduce the risk of contrast-induced acute kidney injury after using contrast media, including increase in creatinine, and decrease in eGFR.