天津医药

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N-乙酰半胱氨酸对冠状动脉介入治疗后对比剂肾病的预防作用

王勇1, 杨世诚2   

  1. 1. 天津医科大学研究生院
    2. 天津市胸 科医院心内一科
  • 收稿日期:2012-08-09 修回日期:2012-10-08 出版日期:2013-07-15 发布日期:2013-07-15
  • 通讯作者: 王勇

The Preventive Effects of N-Acetylcysteine on Contrast-Induced Nephropathy in Patients Undergoing Elective Percutaneous Coronary Intervention

  1. 1. Graduate School of Tianjin Medical University, Tianjin 300070, China
    2.
  • Received:2012-08-09 Revised:2012-10-08 Published:2013-07-15 Online:2013-07-15
  • Contact: WANG Yong

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摘要：

【摘要】 目的  探讨N-乙酰半胱氨酸(NAC)对择期经皮冠状动脉介入治疗(PCI)术后发生对比剂肾病(CIN)是否具有预防作用。方法  选取行择期PCI术的患者521例,随机分为NAC组和常规治疗组,其中NAC组260例,给予NAC+水化治疗;常规治疗组261例,仅给予水化治疗。观察2组PCI术前及术后72h血肌酐(Scr)、尿素氮(BUN)、肌酐清除率(Ccr)、C-反应蛋白(CRP)、β2微球蛋白(β2-MG)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、过氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GPX)及CIN发病率的变化。结果  (1)NAC组的CIN发病率(6.2%)与常规治疗组(3.8%)差异无统计学意义(χ2=1.48,P>0.05)。(2)2组PCI术前的血Scr、BUN、Ccr、CRP、β2-MG、TNF-α、IL-6、SOD及GPX水平差异无统计学意义(P>0.05)。(3)PCI术后72h,2组CRP、SOD、GPX均较术前升高(P<0.05);NAC组CRP、SOD、GPX水平低于常规治疗组(P<0.05);NAC组Scr、BUN、β2-MG、Ccr水平较常规治疗组无明显变化(P>0.05)。结论 NAC对PCI术后CIN的发生可能无预防作用。 

关键词: 乙酰半胱氨酸, 肾疾病, 造影剂, 碘帕醇, 血管成形术, 经腔, 经皮冠状动脉, 对比剂肾病

Abstract: Abstract   Objective   To investigate the preventive effect of N?acetylcysteine(NAC) on contrast induced nephropathy（CIN） in patients undergoing elective percutaneous coronary intervention（PCI）.Methods   five hundreds and twenty one patients who are about to undergo PCI in Tianjin Chest Hospital are randomly divided into either conventional treatment group（n=261） or NAC treatment group（n=260）. NAC treatment group are received oral NAC (600mg twice daily) for 48h preoperative and 72h postoperative PCI plug hydration, and the conventional treatment group are received only hydration. The levels of blood serum creatinine（Scr）,urea nitrogen（BUN）, creatinine clearance rate （Ccr）, C-reactive protein（CRP）, β2-microglobulin（β2-MG）, tumor necrosis factor-α（TNF-α）, interleukin-6（IL-6）, Superoxidedismutase（SOD）,Glutathione reductase（GSH） were measured at admission and 72h after the procedure. Result   （1）In the NAC treatment group, 16 patients present with CIN，the incidence of CIN was 6.2%;In the conventional treatment group, CIN occur in 10 patients, the incidence of CIN was 3.8%（χ2=1.48，p>0.05）.（2）There was no statistically difference in the levels of Scr,BUN,CRP、β2-MG,TNF-α,IL-6 ,SOD,GSH at admission（P>0.05）. 72h after the procedure, the levels of CRP、SOD、GSH were lower in NAC treatment group than the conventional treatment group, and the levels of CRP,SOD,GSH were higher than preoperative. Conclusion   Oxidative stress and inflammation may play a important role in the pathogenesis of CIN, N?acetylcysteine may not be beneficial in the prevention of CIN.

Key words: acetyl-cysteine, kidney diseases, Contrast agent, iopamidol, angioplasty, transluminal, percutaneous coronary, 对比剂肾病