Objective To study the role of prostaglandin E1 in prevention of contrast-induced ne-phropathy (CIN)in elderly CHD patients undergoing PCI .Methods Three hundred elderly CHD patients who were going to undergo PCI in Tianjin Chest Hospital were divided into prostaglandin E1 treatment group (n=150) and conventional treatment group (n=150) .Patients in prostaglan-din E1 treatment group were treated with 20 μg prostaglandin E1 plus hydration therapy and those in conventional treatment group received simple hydration therapy .T heir serum levels of creatinine ,urea ,β2-microglobulin ,24 h proteinuria ,CRP ,IL-6 ,TNF-α,GPX ,SOD ,and creatinine clearance rate were measured before and 3 d after PCI .The incidence of CIN in two groups was analyzed .The hypotension events in prostaglandin E1 treatment group were recorded .Results The serum levels of CRP ,SOD ,GPX ,24 h proteinuria and the incidence of CIN were significantly lower while the creatinine clearance rate was significantly higher in prostaglandin E 1 treatment group than in conventional treatment group after PCI (P<0 .05) .The serum levels of CRP ,IL-6 , SOD ,GPX and 24 h proteinuria were significantly higher in two groups after PCI than before PCI (P<0 .05) .Conclusion Prostaglandin E1 can protect the renal function in CHD patients under-going PCI and play a certain role in preventing CIN .

Objective To study the role of N‐acetylcysteine (NAC) in protecting rats against con‐trast‐induced acute kidney injury .Methods Forty‐five adult Wistar rats were randomly divided into control group ,model group and NAC group (15 in each group) .Their serum levels of creati‐nine ,CRP ,TNF‐a were measured before ,and 48 and 72 h after contrast medium injection .The an‐imals were killed 72 h after contrast medum injection .Their serum levels of malondialdehyde , SOD ,NO were measured .Eexpressions of Bax and Bcl‐2 were detected .Results The serum levels of creatinine ,CRP ,TNF‐a ,malondialdehyde and the expression level of Bax were significantly higher in model group and NAC group than in control group ,and in model group than in NAC group after contrast injection (P< 0 .05) .The serum levels of SOD and NO and the expression level of Bcl‐2 were significantly lower in model group and NAC group than in control group ,and in model group than in NAC group after constrast injection (P< 0 .05) .Immunohistochemistry demonstrated that the TGFβ1 expression level was significantly higher in model group and NAC group than in control group and was significantly lower in NAC group than in model group .Con‐clusion NAC can protect rats against kidney injury and reduce contrast‐induced acute kidney in‐jury by inhibiting inflammation ,oxidation ,apoptosis and cytokines .

Objective To investigate the cause and countermeasures of frequent shocks in patients with implantable cardioverter defibrillators (ICD). Methods Eighty ICD patients with heart failure and malignant ventricular arrhythmias were followed up, including sixty-two male and eighteen female patients. There were 35 patients with single-chamber ICD, 23 with dual-chamber ICD and 22 with three-chamber ICD. Patients in this study were followed up for 1-6 years to analyze the reasons for ICD discharge. According to the specific circumstances, patients were treated. Results Twenty-three pa-tients in 80 patients suffered from shock treatment. Ten patients (12.5%) experienced frequent shocks. The causes of fre-quent shock included repeated episodes of ventricular tachycardia, invalid shock due to increased defibrillation threshold (DF) and false identification of the frequent episodes of paroxysmal ventricular tachycardia or arrhythmias. The management included the identification process adjustment of ventricular tachycardia and supraventricular tachycardia, increased num-bers of beats of ventricular tachycardia judgment and increase the basic pacing rate. The anti-arrhythmic drugs should be combinedly used, especially metoprolol and amiodarone. The ICD shock was significantly reduced after parameter optimiza-tion and anti-arrhythmic therapy. Conclusion The ICD shocks were effectively reduced with rational use of anti-arrhyth-mic drugs and valid ICD programming.

Objective To investigate the relationship of low level of high-density lipoprotein cholesterol to contrast induced-acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) in patients with coronary heart disease.Methods A total of 1500 consecutive patients,who underwent PCI from January 2009 to May 2011,were enrolled in this study.There was no limit on age or sex,and all patients were self-identified as Han ethnic group.Patients were excluded from this study,however,if they had a history of malignant tumor,urinary tract infection,nephrectomy operation,chronic peritoneal or hemodialysis,or if they had been exposed to contrast media within the past 14 days.CI-AKI was defined as an absolute increase in serum creatinine ≥44.2 μmol/L or a relative ≥25％ increase in serum creatinine within 72 hours after procedure.Low level of HDL-C was defined as ＜ 1.04 mmol/L.Monofactorial and multivariate analysis was performed to identify risk factors for CI-AKI and low level of HDL-C in these patients.Results Among the 1500 patients with coronary heart disease,CI-AKI occurred in 246 patients after PCI and the overall incidence of CI-AKI was 16.4％.The patients with low level of HDL-C had a higher incidence of CI-AKI than those without it (21.5％ vs.13.3％ in total,P ＜0.01),no matter that they had suffered from chronic kidney disease (39.8％ vs.26.5％,P ＜ 0.05) or not (17.7％ vs.9.7％,P ＜ 0.01).By multivariate analysis,low level of HDL-C was identified as an independent risk factor for CI-AKI and smoke,great BMI as well as anemia were considered as prediction factors for low level of HDL-C.Conclusion The patients with low level of HDL-C have a higher incidence of CI-AKI after PCI.Low level of HDL-C is one of risk factors for CI-AKI after PCI in patients either with chronic kidney disease or not.Great BMI,smoking as well as anemia are independent predictors for low HDL-C level in these patients.

Objective To observe the effect of different doses of atorvastatin combined with probucol on contrast induced acute kidney injury (CIAKI) and serum uric acid in elderly patients.Methods Totally 121 cases admitted for coronary angioplasty were randomly divided into three groups.In standard combining treatment group (n＝35),atorvastatin 20 mg qn and probucol 0.25 g,tid were given with no loading dose intake before angioplasty.In intensively combined treatment group (n＝41),atorvastatin 40mg qn and probucol 0.25 g,tid were given with a loading dose of atorvastatin 40 mg and probucol 0.5 g at 2 hours before angioplasty.In intensive atorvastatin therapy group(n＝45),atorvastatin 40 mg qn were given,with a loading dose of atorvastatin 40 mg 2 hours before angioplasty.All patients were then evaluated 24 hours before and after angioplasty procedure,and their blood urea nitrogen (BUN),serum creatinine (Scr),serum uric acid (SUA),estimated glomerular filtration rate (eGFR) by modified diet in renal disease study (MDRD) method were tested.The serum and urine at 24 hours before and after operation were collected.Neutrophil gelatinase associated lipocalin (NGAL) were determinated by enzyme linked immunosorbnent assay (ELISA) method.Results After operation,eGFR was decreased in standard combining treatment group [(76.2±14.3) ml· min-1 · 1.73 m-2 vs.(71.9±17.9) ml· min-1 · 1.73 m-2,P＜0.05],while Scr,eGFR and uNGAL showed no changes in intensively combining treatment group and intensive atorvastatin therapy group (P＞0.05) ; BUN in the two groups was decreased [(5.6± 1.4)mmol/L vs.(4.7±0.9) mmol/L,(5.3±1.2) mmol/L vs.(4.8±1.2) mmol/L,P＜0.01,P＜0.05].SUA was reduced in intensively combining treatment group (P ＜ 0.05).uNGAL was increased in standard combining treatment group (P ＜ 0.05).Conclusions For elderly patients,intensive atorvastatin therapy and combining intensive treatment can both improve CIAKI.Only combination and intensive treatment benefit for decrease of uric acid.

Objective To investigate the preventive effect of N-acetylcysteine (NAC) on contrast-induced nephropa-thy (CIN) in patients undergoing elective percutaneous coronary intervention (PCI). Methods A total of 521 patients under-went PCI in Tianjin were randomly divided into conventional treatment group (n=261) and NAC treatment group (n=260). NAC treatment group was given oral NAC (600 mg twice daily) for 48 h and 72 h before PCI plug hydration therapy, and the conventional treatment group was given only hydration therapy. The serum levels of creatinine(Scr), urea nitrogen(BUN), creatinine clearance rate (Ccr), C-reactive protein (CRP),β2-microglobulin(β2-MG), tumor necrosis factor-α(TNF-α), inter-leukin-6 (IL-6), superoxide dismutase (SOD), glutathione peroxidase (GPX) and incidence of CIN were detected at admission and 72 h after the procedure. Results (1) There was no significant difference in the incidence of CIN between NAC treat-ment group (6.2%) and conventional treatment group (3.8%,χ2=1.48, P>0.05). (2) There were no significant differences in se-rum levels of Scr, BUN, Ccr, CRP,β2-MG, TNF-α, IL-6, SOD and GPX before PCI ( P>0.05). (3) The serum levels of CRP, SOD and GPX were significantly higher 72 h after the procedure in two groups ( P＜0.05). There were significantly lower se-rum levels in CRP, SOD and GPX in NAC treatment group than those of conventional treatment group ( P＜0.05). There were no significant differences in serum levels of Scr, BUN,β2-MG and Ccr between NAC treatment group and conventional treat-ment group ( P >0.05). Conclusion N-acetylcysteine may have no beneficial effect on the prevention of CIN after PCI.

Objective To investigate the impact of dapagliflozin on the incidence of contrast-induced nephropathy(CIN)and prognosis in elderly patients(＞60 years old)with type 2 diabetes mellitus(T2DM)undergoing percutaneous coronary intervention(PCI).Methods A retrospective study was conducted on 296 elderly T2DM patients who underwent PCI in our department from January 2021 to June 2022.With a propensity score matching at a ratio of 1∶1,according to ad-ministration of dapagliflozin or not,they were divided into a dapagliflozin group(148 cases)and a control group(148 cases).Changes in renal function,including blood urea nitrogen(BUN),serum creatinine(Cr),estimated glomerular filtration rate(eGFR),β2-microglobulin(β2-MG),cystatin C(Cys C),and neutrophil gelatinase-associated lipocalin(NGAL),were detected and calculated in both groups before and in 72 h after PCI.The incidence of CIN was recorded in the two groups,and logistic regression analysis was used to determine the effect of dapagliflozin on the occurrence of CIN.The occurrence of major adverse cardiac events(MACE)was observed in the two groups during follow-up period,and Kaplan-Meier curve analysis and Log-rank test were applied to com-pare the differences in the occurrence.Results There were no significant differences in the general clinical data between the two groups(P＞0.05).Serum levels of Cys C,β2-MG,and NGAL were increased in both groups in 72 h after PCI,with these levels obviously lower in the dapagliflozin group than the control group(P＜0.05,P＜0.01).The dapagliflozin group experienced a lower incidence of CIN than the control group(4.7％vs 12.2％,P=0.035).Logistic regression analysis indicated that dapagliflozin was an independent protective factor for CIN(OR=0.256,95％CI:0.083-0.796,P=0.019).In a follow-up period of 14.25±2.15 months,a lower incidence rate of MACE was observed in the dapagliflozin group than the control group(Log rank x2=5.257,P=0.022;HR=0.460,95％CI:0.237-0.893).Conclusion Dapagliflozin may reduce the occurrence of CIN and MACE in elderly patients with T2DM after PCI.

Objective To investigate the impact of liraglutide on contrast-induced nephropathy(CIN)and prognosis in elderly patients with type 2 diabetes(T2DM)after PCI.Methods A ret-rospective trial was conducted on 364 elderly T2DM patients undergoing PCI in Department of Cardiology of Tianjin Chest Hospital from January 2021 to June 2022.According to whether lira-glutide was used in the past,they were divided into liraglutide group(n=145)and control group(n=219).Their general clinical data were collected in the two groups.Propensity score matching was used to adjust confounding factors and to assign the patients.After propensity score matc-hing,there were 220 patients finally included,with 110 in each group.The levels of serum creati-nine(Scr),blood urea nitrogen(BUN),neutrophil gelatinase-associated lipocalin(NGAL),hyper-sensitive C-reactive protein(hs-CRP),malondialdehyde(MDA),superoxide dismutase(SOD),Bax/BCL-2 and Caspase 9,and incidence of CIN were compared before and in 48 h after PCI be-tween the matched patients from the two groups.These patients were followed up for 18 months after discharge.Multivariate logistic regression analysis was employed to determine the effect of liraglutide on the occurrence of CIN.Kaplan-Meier curve analysis and Log rank test were applied to compare the differences in the incidence of major adverse cardiovascular events(MACE)be-tween 2 groups.Results The levels of Scr,BUN,NGAL,hs-CRP,and MDA were significantly lower,and SOD level was obviously higher in the liraglutide group than the control group in 48 h after PCI(P＜0.05,P＜0.01).The liraglutide group had notably lower incidence of CIN than the control group within 48 h after PCI(7.27％vs 16.36％,P＜0.05).Multivariate logistic regression analysis indicated liraglutide as an independent protective factor against CIN(OR=0.341,95％CI:0.128-0.906,P=0.031).During the median follow-up period of 14.75(12.60,16.33)months,a lower MACE occurrence rate was seen in the liraglutide group than the control group(log rank x2=5.656,P=0.017).Conclusion Liraglutide can reduce the incidences of CIN and MACE in elderly T2DM patients after PCI,which may be associated with its anti-inflammatory and antioxidant effects.

Objective To investigate the influences of Qishen Yiqi dropping pills on serum IL-18 level and prognosis in elderly hypertension patients complicated with acute coronary syndrome(ACS).Methods A prospective study was performed on 330 patients with hypertension compli-cated by ACS treated in our hospital from January 2020 to January 2022.They were randomly di-vided into dropping pills treatment group(n=164)and control group(n=166).The control group received standard Western medicine treatment,and on the basis of the treatment,the treat-ment group were given Qishen Yiqi dropping pills.The baseline clinical data,serum IL-18 level,blood pressure,and blood lipid and glucose levels in 1 year after treatment and the incidence rate of MACE within 1 year of follow-up were compared between the two groups.Multivariate logistic regression analysis was applied to identify influencing factors for reoccurrence of MACE in elderly patients with hypertension complicated by ACS.ROC curve was plotted to study the value of IL-18 in predicting MACE in the patients.Results In 1 year after treatment,SBP and DBP levels,serum levels of IL-18,LDL-C and TC,and the incidence of MACE were significantly lower in the treatment group than the control group(P＜0.05).Multivarate logistic regression analysis re-vealed that Qishen Yiqi dropping pill was an independent protective factor for MACE(OR=0.259,95％CI:0.087-0.772,P=0.010),while higher serum IL-18 level was a risk factor for MACE(OR=1.075,95％CI:1.046-1.106,P=0.000)in the elderly hypertension patients com-plicated by ACS.The AUC value of serum IL-18 level in predicting MACE in the patients with hypertension complicated by ACS was 0.786(95％CI:0.696-0.877,P＜0.01),with a sensitivity and a specificity of 65.00％and 90.00％respectively.Conclusion Serum IL-18 level has a predic-tive value for prognosis in elderly hypertension patients complicated with ACS.Qishen Yiqi drop-ping pills can reduce serum IL-18 level,blood pressure and lipids,attenuate inflammatory re-sponse,and consequently decrease the risk of MACE and improve prognosis in the patients.