Efrati Shai, Dishy Victor, Averbukh Michael, Blatt Alex, Krakover Ricardo, Weisgarten Joshua, Morrow Jason D, Stein Michael C, Golik Ahuva
Department of Medicine A, Division of Cardiology, Asaf Harofeh Medical Center, Zerifin, Israel.
Kidney Int. 2003 Dec;64(6):2182-7. doi: 10.1046/j.1523-1755.2003.00322.x.
Renal failure induced by radiographic contrast agents is a known complication of coronary angiography, especially among patients with chronic renal failure. Recently, treatment with N-acetylcysteine (NAC) has been shown to have a protective effect but the mechanisms are unknown. We examined the hypothesis that NAC protected against contrast-induced renal impairment through effects on nitric oxide metabolism and oxidative stress.
Patients with a serum creatinine concentration above 10(6) micromol/L undergoing coronary angiography were randomly assigned to receive either NAC 1 g (N= 24) or placebo (N= 29) twice daily 24 hours before and after angiography with 0.45% saline hydration in a double-blind study. Creatinine clearance was calculated and urinary nitric oxide and F2-isoprostane excretion were measured at baseline, 24 and 96 hours after angiography.
Treatment with NAC significantly improved the effect of contrast media on creatinine clearance, and maximal beneficial effect was observed 24 hours after angiography. Creatinine clearance (mL/min) was 59.5 +/- 4.4, 64.7 +/- 5.8, and 58.7 + 3.9 at baseline, 24, and 96 hours after angiography in the NAC group, respectively, and 65.2 +/- 3.2, 51.5 +/- 3.7, and 53.6 +/- 3.9 in the placebo group, respectively (P < 0.0001). NAC treatment prevented the reduction in urinary nitric oxide after angiography. The urinary nitric oxide/creatinine ratio (micromol/mg) was 0.0058 +/- 0.0004, 0.0057 +/- 0.0004, and 0.0052 +/- 0.0004 at baseline, 24, and 96 hours after angiography in NAC group, respectively, and 0.0057 +/- 0.0007, 0.0031 +/- 0.0005, and 0.0039 +/- 0.0005 in the placebo group, respectively (P= 0.013). NAC had no significant effect on urinary F2-isoprostanes.
NAC treatment has renoprotective effect in patients with mild chronic renal failure undergoing coronary angiography that may be mediated in part by an increase in nitric oxide production.
放射造影剂所致肾衰竭是冠状动脉造影已知的并发症，尤其在慢性肾衰竭患者中。最近，已证明N - 乙酰半胱氨酸（NAC）治疗具有保护作用，但机制尚不清楚。我们检验了NAC通过对一氧化氮代谢和氧化应激的影响来预防造影剂所致肾损害的假说。
在一项双盲研究中，血清肌酐浓度高于106微摩尔/升且接受冠状动脉造影的患者被随机分配，在造影前和造影后24小时每天两次接受1克NAC（N = 24）或安慰剂（N = 29），同时给予0.45%盐水水化。计算肌酐清除率，并在基线、造影后24小时和96小时测量尿一氧化氮和F2 - 异前列腺素排泄。
NAC治疗显著改善了造影剂对肌酐清除率的影响，造影后24小时观察到最大有益效果。NAC组造影后基线、24小时和96小时的肌酐清除率（毫升/分钟）分别为59.5±4.4、64.7±5.8和58.7 + 3.9，安慰剂组分别为65.2±3.2、51.5±3.7和53.6±3.9（P < 0.0001）。NAC治疗可预防造影后尿一氧化氮的降低。NAC组造影后基线、24小时和96小时的尿一氧化氮/肌酐比值（微摩尔/毫克）分别为0.0058±0.0004、0.0057±0.0004和0.0052±0.0004，安慰剂组分别为0.0057±0.0007、0.0031±...
