Vallero A, Cesano G, Pozzato M, Garbo R, Minelli M, Quarello F, Formica M
UU.OO. Nefrologia-Dialisi, Ospedale Torino Nord Emergenza San Giovanni Bosco, Torino, Italy.
G Ital Nefrol. 2002 Sep-Oct;19(5):529-33.
Acute renal failure induced by contrast agents represents the third cause of acute nephropathy in hospitalized patients. Some mediators are potentially involved in this process: recent data underscored the role of oxidising agents and prophylactic administration of NAC showed a lower incidence of acute renal damage after using contrast agents.
We analyzed 100 patients consecutively undergoing coronary angiography and/or transluminal angioplasty: the study group was given NAC orally at a dose of 600 mg twice daily, on the day before and on the day of administration of the contrast agent, together with hydration, while the control group was given only the hydration protocol with hypotonic saline.
Twenty patients had baseline serum creatinine concentrations > 1.2 mg/dL (mild renal insufficiency group). The mean dose of contrast agent (Iodixanol; Visipaque 320, Nycomed) was 203 mL/procedure, with no statistical difference between groups. Among the patients with normal renal function, 5.7% in the NAC group and 8.8% in the control group had baseline serum creatinine concentrations above 0.3 mg/dL after 48 hours (p=NS). In patients with mild renal failure, 16.6% in the NAC group and 0% in the control group had serum creatinine concentrations > 0.5 mg/dL at 48 h (p=NS). We found no significant differences in serum creatinine values at 48 hours vs. baseline in anyone (NAC group with normal renal function or mild renal insufficiency, control group with normal renal function or mild renal insufficiency). Similarly, serum creatinine values at either baseline or after 48 hours were not significantly different in patients with normal renal function (NAC vs. control group) and with mild renal failure.
Our study showed no potential advantage in the prevention of acute nephropathy, induced by high volumes of contrast agent, through the administration of NAC in patients with normal renal function and mild renal failure. However, the NAC dose used in our study might not be sufficient in balancing the contrast agent volume employed in these procedures.
造影剂所致急性肾衰竭是住院患者急性肾病的第三大病因。一些介质可能参与了这一过程：近期数据强调了氧化剂的作用，预防性给予N - 乙酰半胱氨酸（NAC）显示使用造影剂后急性肾损伤的发生率较低。
我们连续分析了100例接受冠状动脉造影和/或经皮腔内血管成形术的患者：研究组在造影剂给药前一天及给药当天，每天两次口服600mg NAC，并进行水化治疗，而对照组仅采用低渗盐水进行水化方案。
20例患者基线血清肌酐浓度>1.2mg/dL（轻度肾功能不全组）。造影剂（碘克沙醇；威视派克320，奈科明公司）的平均剂量为每次203mL，两组间无统计学差异。在肾功能正常的患者中，48小时后NAC组5.7%、对照组8.8%的患者基线血清肌酐浓度高于0.3mg/dL（p = 无统计学意义）。在轻度肾衰竭患者中，48小时时NAC组16.6%、对照组0%的患者血清肌酐浓度>0.5mg/dL（p = 无统计学意义）。我们发现，无论是48小时时还是与基线相比，任何人（肾功能正常或轻度肾功能不全的NAC组、肾功能正常或轻度肾功能不全的对照组）的血清肌酐值均无显著差异。同样，肾功能正常（NAC组与对照组）和轻度肾衰竭患者的基线或48小时后的血清肌酐值也无显著差异。
我们的研究表明，对于肾功能正常和轻度肾衰竭的患者，通过给予NAC预防大量造影剂所致急性肾病并无潜在优势。然而，我们研究中使用的NAC剂量可能不足以平衡这些操作中使用的造影剂剂量。
