Briguori Carlo, Manganelli Fiore, Scarpato Pierfranco, Elia Pietro Paolo, Golia Bruno, Riviezzo Guido, Lepore Stefano, Librera Mariateresa, Villari Bruno, Colombo Antonio, Ricciardelli Bruno
Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Via Orazio 2, I-80121 Naples, Italy.
J Am Coll Cardiol. 2002 Jul 17;40(2):298-303. doi: 10.1016/s0735-1097(02)01958-7.
Prophylactic acetylcysteine along with hydration seems to be better than hydration alone in preventing the reduction in renal function induced by a contrast dye.
Contrast media can lead to acute renal failure that may occasionally require hemodialysis.
One hundred eighty-three consecutive patients with impairment of renal function, undergoing coronary and/or peripheral angiography and/or angioplasty, were randomly assigned to receive 0.45% saline intravenously and acetylcysteine (600 mg orally twice daily; group A, n = 92) or 0.45% saline intravenously alone (group B, n = 91) before and after nonionic, low-osmolality contrast dye administration.
The baseline serum creatinine concentrations were similar (1.5 +/- 0.4 mg/dl in group A vs. 1.5 +/- 0.4 mg/dl in group B; p = 0.37). An increase of > or =25% in the baseline creatinine level 48 h after the procedure occurred in 6 (6.5%) of 92 patients in group A and in 10 (11%) of 91 patients in group B (p = 0.22). In the subgroup with a low (<140 ml) contrast dose, renal function deterioration occurred in 5 (8.5%) of 60 patients in group B and in 0 of 60 patients in group A (p = 0.02; odds ratio [OR] 0.44, 95% confidence interval [CI] 0.35 to 0.54). In the subgroup with a high contrast dose, no difference was found (5/31 vs. 6/32 patients, p = 0.78). By multivariate analysis, the amount of contrast agent, but not the treatment strategy, was a predictor of the occurrence of contrast dye-associated nephrotoxicity (OR 2.58, 95% CI 1.1 to 4.9; p = 0.035).
In patients with reduced renal function undergoing angiography and/or angioplasty, the amount of contrast agent, but not the administration of prophylactic acetylcysteine, was a predictor of renal function deterioration. Prophylactic acetylcysteine might provide better protection than hydration alone, only when a small volume of contrast agent is used.
在预防造影剂引起的肾功能减退方面，预防性使用乙酰半胱氨酸并联合补液似乎比单纯补液效果更好。
造影剂可导致急性肾衰竭，偶尔可能需要进行血液透析。
183例连续的肾功能不全患者，接受冠状动脉和/或外周血管造影及/或血管成形术，在使用非离子型、低渗造影剂之前和之后，被随机分配接受静脉输注0.45%盐水和乙酰半胱氨酸（每日口服两次，每次600毫克；A组，n = 92）或仅静脉输注0.45%盐水（B组，n = 91）。
基线血清肌酐浓度相似（A组为1.5±0.4毫克/分升，B组为1.5±0.4毫克/分升；p = 0.37）。术后48小时基线肌酐水平升高≥25%的情况，A组92例患者中有6例（6.5%）出现，B组91例患者中有10例（11%）出现（p = 0.22）。在造影剂剂量低（<140毫升）的亚组中，B组60例患者中有5例（8.5%）出现肾功能恶化，A组60例患者中无1例出现（p = 0.02；优势比[OR] 0.44，95%置信区间[CI] 0.35至0.54）。在造影剂剂量高的亚组中，未发现差异（5/31对6/32例患者，p = 0.78）。通过多变量分析，造影剂的用量而非治疗策略是造影剂相关肾毒性发生的预测因素（OR 2.58，95% CI 1.1至4.9；p = 0.035）。
在接受血管造影和/或血管成形术的肾功能减退患者中，造影剂的用量而非预防性使用乙酰半胱氨酸是肾功能恶化的预测因素。仅当使用少量造影剂时，预防性使用乙酰半胱氨酸可能比单纯补液提供更好的保护。
