Association between high sensitivity C-reactive protein and contrast induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention: impact of atorvastatin / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the association between preprocedural high sensitivity C-reactive protein (hs-CRP) level and incidence of contrast induced acute kidney injury (CI-AKI) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) and the impact of atorvastatin pretreatment on CI-AKI.</p><p><b>METHODS</b>According to the level of preprocedural hs-CRP, 270 ACS patients were divided into three groups: high hs-CRP group (hs-CRP ≥ 3 mg/L, n = 176), moderate hs-CRP group (hs-CRP 1-3 mg/L, n = 60) and normal hs-CRP group (hs-CRP < 1 mg/L, n = 34). According to the dosage of preprocedural atorvastatin, the high hs-CRP group was further divided into 10 mg group (n = 49), 20 mg group (n = 66) and 40 mg group (n = 61). Serum creatinine (Scr), blood urea nitrogen (BUN), cystatin C (Cys C), hs-CRP were measured at before and 24 hours, 48 hours after PCI. CCr and GFR were calculated according to Scr and Cys C. Risk factors for CI-AKI were determined by multivariate logistic regression analysis.</p><p><b>RESULTS</b>(1) Cys C was significantly increased and GFR after PCI significantly reduced in high and moderate hs-CRP groups compared with normal hs-CRP group (P < 0.05). (2) Incidence of CI-AKI was 43.18%, 38.33%, 20.59% in high, moderate and normal hs-CRP groups, respectively (P < 0.05). (3) In high hs-CRP group, postprocedural GFR was significantly higher while postprocedural Cys C and hs-CRP were significantly lower in 40 mg statin subgroup than 10 mg and 20 mg statin subgroups (P < 0.05), similar trends were documented when comparing 20 mg statin subgroup with 10 mg statin subgroup (P < 0.05). (4) Multivariate logistic regression analysis showed that pretreatment with high dose atorvastatin was a protective factor for post CI-AKI (20 mg atorvastatin: OR = 0.15, 95%CI 0.06 - 0.33, P = 0.001; 40 mg atorvastatin: OR = 0.10, 95%CI 0.04 - 0.23, P = 0.001), while high levels of preprocedural hs-CRP (OR = 2.06, 95%CI 1.01 - 4.23, P = 0.048), diabetes mellitus (OR = 10.71, 95%CI 5.29 - 21.70, P = 0.001), advanced age (OR = 2.64, 95%CI 1.05 - 6.63, P = 0.038) and renal failure (OR = 5.14, 95%CI 1.13 - 23.39, P = 0.034) were independent risk factors of CI-AKI.</p><p><b>CONCLUSION</b>High hs-CRP level is linked with the development of CI-AKI in ACS patients undergoing PCI and pretreatment with 40 mg atorvastatin is associated with lower incidence CI-AKI, possibly by reducing the postprocedural inflammation responses.</p>

Impact of acute glucose and fat loading on endothelium dependent vasodilation in patients with essential hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the influence of acute glucose and fat loading on endothelium dependent flow-mediated vasodilation (FMD) in patients with essential hypertension (EH).</p><p><b>METHODS</b>Patients with EH were randomly divided into three groups: oral glucose loading alone (n = 26), oral standardized fat loading alone (n = 38), combined glucose and fat loading (n = 34). FMD of the brachial artery was assessed by high resolution ultrasound technique respectively.</p><p><b>RESULTS</b>(1) Compared to control group, postprandial abnormal serum triglyceride metabolism was evidenced and FMD was significantly reduced and the lowest FMD occurred at 4 hours and returned to the baseline level at 8 hours post fat loading alone in EH patients. (2) GS-AUC and 1 hour glucose were significantly higher in EH patients than in controls (all P < 0.05), FMD was also significant decreased (-31.4%) at 1 hour and returned to baseline level at 2 hours post oral glucose loading. (3) After combined glucose and fat loading, FMD at 1 hour (5.45 ± 1.93 vs. 9.46 ± 3.33, P < 0.05) was significantly lower than that in glucose loading alone and FMD at 4 hours (7.98 ± 1.64 vs. 9.66 ± 2.26, P < 0.05), was also lower than that in fat loading alone in EH patients. (4) FMD was negatively correlated with SBP, GS-AUC, DBP, TG-AUC (γ = -0.46, -0.44, -0.41, -0.38, respectively, all P < 0.05).</p><p><b>CONCLUSION</b>Combined glucose and fat loading additively reduced FMD in hypertensive patients.</p>