Briguori Carlo, Colombo Antonio, Airoldi Flavio, Violante Anna, Castelli Alfredo, Balestrieri Pasquale, Paolo Elia Pietro, Golia Bruno, Lepore Stefano, Riviezzo Guido, Scarpato Pierfranco, Librera Mariateresa, Focaccio Amelia, Ricciardelli Bruno
Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
J Am Coll Cardiol. 2004 Aug 18;44(4):762-5. doi: 10.1016/j.jacc.2004.04.052.
We performed a study to assess the efficacy of fenoldopam mesylate (a specific agonist of the dopamine-1 receptor) as compared with N-acetylcysteine (NAC) in preventing contrast agent-associated nephrotoxicity (CAN).
Prophylactic administration of NAC, along with hydration, prevents CAN in patients with chronic renal insufficiency who are undergoing contrast media administration. Preliminary data support the hypothesis that fenoldopam might be as effective as NAC.
One hundred ninety-two consecutive patients with chronic renal insufficiency, referred to our institution for coronary and/or peripheral procedures, were assigned randomly to receive 0.45% saline intravenously and NAC (1,200 mg orally twice daily; NAC group; n = 97) or fenoldopam (0.10 microg/kg/min; fenoldopam group; n = 95) before and after a nonionic, iso-osmolality contrast dye administration.
Baseline creatinine levels were similar in the two groups: NAC group = 1.72 mg/dl (interquartile range, 1.55 to 1.90 mg/dl) and fenoldopam group = 1.75 mg/dl (interquartile range, 1.62 to 2.01 mg/dl) (p = 0.17). An increase of at least 0.5 mg/dl of the creatinine concentration 48 h after the procedure occurred in 4 of 97 patients (4.1%) in the NAC group and in 13 of 95 patients (13.7%) in the fenoldopam group (p = 0.019; odds ratio 0.27; 95% confidence interval 0.08 to 0.85). The amount of contrast media administration was similar in the two groups (NAC group = 160 +/- 82 ml; fenoldopam group = 168 +/- 104 ml; p = 0.54).
N-acetylcysteine seems to be more effective than fenoldopam in preventing CAN.
我们开展了一项研究，以评估甲磺酸非诺多泮（一种多巴胺 -1 受体特异性激动剂）与 N - 乙酰半胱氨酸（NAC）相比在预防造影剂相关性肾毒性（CAN）方面的疗效。
对于接受造影剂注射的慢性肾功能不全患者，预防性给予 NAC 并进行水化治疗可预防 CAN。初步数据支持非诺多泮可能与 NAC 同样有效的假设。
192 例因冠状动脉和/或外周手术转诊至我院的慢性肾功能不全患者，在接受非离子等渗造影剂注射前后，被随机分配接受静脉注射 0.45%盐水及 NAC（口服 1200mg，每日两次；NAC 组；n = 97）或非诺多泮（0.10μg/kg/min；非诺多泮组；n = 95）。
两组患者的基线肌酐水平相似：NAC 组为 1.72mg/dl（四分位间距，1.55 至 1.90mg/dl），非诺多泮组为 1.75mg/dl（四分位间距，1.62 至 2.01mg/dl）（p = 0.17）。术后 48 小时肌酐浓度至少升高 0.5mg/dl 的情况在 NAC 组 97 例患者中有 4 例（4.1%）出现，在非诺多泮组 95 例患者中有 13 例（13.7%）出现（p = 0.019；优势比 0.27；95%置信区间 0.08 至 0.85）。两组造影剂注射量相似（NAC 组 = 160±82ml；非诺多泮组 = 168±104ml；p = 0.54）。
在预防 CAN 方面，N - 乙酰半胱氨酸似乎比非诺多泮更有效。
