Kefer Joëlle M, Hanet Claude E, Boitte Sabine, Wilmotte Léon, De Kock Martine
Division of Cardiology, University of Louvain, Brussels, Belgium.
Acta Cardiol. 2003 Dec;58(6):555-60. doi: 10.2143/AC.58.6.2005321.
This study was designed to determine whether acetylcysteine could provide a protective effect on renal function in a population of patients with normal renal function or mild to moderate chronic renal failure, usually referred for a coronary procedure.
Contrast-induced nephropathy is a well-recognized complication of coronary angiography. Recent studies suggest that saline hydration and acetylcysteine reduce the incidence of contrast-induced worsening of renal function in patients with pre-existing chronic renal failure who are undergoing computed tomography examinations.
One hundred eight patients were blindly and randomly assigned to receive either acetylcysteine or placebo before and after administration of contrast agent in association with a moderate hydration protocol. Serum creatinine and urea nitrogen were measured before and 24 hours after coronary procedure.
The mean serum creatinine concentration remained unchanged 24 hours after contrast agent administration in both groups: from 1.04 +/- 0.26 to 1.03 +/- 0.29 mg/dl in the acetylcysteine group and from 1.16 +/- 1.1 to 1.06 +/- 0.41 mg/dl in the control group (p = 0.29, for the comparison between two groups, NS). We divided the population into 3 subgroups according to their creatinine clearance: no significant change of serum creatinine concentration was observed in patients with normal renal function nor in patients with pre-existing mild to moderate chronic renal failure in both groups. There was no significant difference for the incidence of contrast-induced nephropathy between both groups (2 of the 53 patients in the acetylcysteine group and 3 of the 51 patients in the placebo group, p = 0.98, NS).
Our data do not support the systematic use of acetylcysteine before a coronary procedure in patients with normal renal function or mild to moderate chronic renal failure, to prevent contrast-induced nephropathy.
本研究旨在确定乙酰半胱氨酸对肾功能正常或轻度至中度慢性肾衰竭患者（通常因冠状动脉手术前来就诊）的肾功能是否具有保护作用。
造影剂肾病是冠状动脉造影公认的并发症。最近的研究表明，生理盐水水化和乙酰半胱氨酸可降低接受计算机断层扫描检查的已有慢性肾衰竭患者造影剂导致肾功能恶化的发生率。
108例患者在造影剂给药前后与适度水化方案联合使用时，被随机盲法分配接受乙酰半胱氨酸或安慰剂。在冠状动脉手术前和术后24小时测量血清肌酐和尿素氮。
两组在造影剂给药后24小时，平均血清肌酐浓度均未改变：乙酰半胱氨酸组从1.04±0.26mg/dl变为1.03±0.29mg/dl，对照组从1.16±1.1变为1.06±0.41mg/dl（两组比较，p = 0.29，无统计学意义）。我们根据肌酐清除率将患者分为3个亚组：两组中肾功能正常的患者以及已有轻度至中度慢性肾衰竭的患者，血清肌酐浓度均未观察到显著变化。两组之间造影剂肾病的发生率无显著差异（乙酰半胱氨酸组53例患者中有2例，安慰剂组51例患者中有3例，p = 0.98，无统计学意义）。
我们的数据不支持在肾功能正常或轻度至中度慢性肾衰竭患者进行冠状动脉手术前系统性使用乙酰半胱氨酸来预防造影剂肾病。
