Hoffmann Ute, Fischereder Michael, Krüger Bernd, Drobnik Wolfgang, Krämer Bernhard K
Department of Internal Medicine II, University of Regensburg, Regensburg, Germany.
J Am Soc Nephrol. 2004 Feb;15(2):407-10. doi: 10.1097/01.asn.0000106780.14856.55.
Prevention of contrast agent-induced nephropathy is of crucial importance for a number of diagnostic studies. N-Acetylcysteine (NAC) was recently reported to decrease serum creatinine levels in this setting, and its administration before radiocontrast medium administration has been widely recommended. The objective of this prospective study was to investigate whether there are effects of NAC on serum creatinine levels that are independent of alterations in GFR. Volunteers with normal renal function who did not receive radiocontrast medium were studied. Fifty healthy volunteers completed the study protocol. NAC was administered orally at a dose of 600 mg every 12 h, for a total of four doses. Surrogate markers of renal function, such as serum creatinine, urea, albumin, and cystatin C levels, were measured and estimated GFR (eGFR) was assessed immediately before the administration of NAC and 4 and 48 h after the last dose. There was a significant decrease in the mean serum creatinine concentration (P < 0.05) and a significant increase in the eGFR (P < 0.02) 4 h after the last dose of NAC. The cystatin C concentrations did not change significantly. In several studies, a protective effect of NAC on renal function after radiocontrast medium administration has been postulated. This is the first study to demonstrate an effect of NAC on creatinine levels and eGFR, surrogate markers of renal injury, without any effect on cystatin C levels. Before renoprotective effects of NAC against contrast agent-induced nephropathy are considered, the direct effects of NAC on creatinine levels, urea levels, and eGFR should be assessed.
预防造影剂所致肾病对于许多诊断性研究至关重要。最近有报道称N-乙酰半胱氨酸（NAC）在此情况下可降低血清肌酐水平，并且广泛推荐在给予放射性造影剂之前使用NAC。这项前瞻性研究的目的是调查NAC对血清肌酐水平是否存在独立于肾小球滤过率（GFR）改变的影响。对未接受放射性造影剂且肾功能正常的志愿者进行了研究。五十名健康志愿者完成了研究方案。NAC以每12小时600毫克的剂量口服，共服用四剂。在给予NAC之前以及最后一剂后4小时和48小时，测量了肾功能的替代指标，如血清肌酐、尿素、白蛋白和胱抑素C水平，并评估了估算的肾小球滤过率（eGFR）。在最后一剂NAC后4小时，平均血清肌酐浓度显著降低（P<0.05），eGFR显著升高（P<0.02）。胱抑素C浓度没有显著变化。在多项研究中，已推测NAC对放射性造影剂给药后肾功能具有保护作用。这是第一项证明NAC对肌酐水平和eGFR（肾损伤的替代指标）有影响，而对胱抑素C水平无任何影响的研究。在考虑NAC对造影剂所致肾病的肾脏保护作用之前，应评估NAC对肌酐水平、尿素水平和eGFR的直接影响。
