Coyle Louis C, Rodriguez Antonio, Jeschke Robert E, Simon-Lee Anabela, Abbott Kevin C, Taylor Allen J
Cardiology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
Am Heart J. 2006 May;151(5):1032.e9-12. doi: 10.1016/j.ahj.2006.02.002.
Patients with diabetes mellitus (DM) are at increased risk of contrast-associated nephropathy irrespective of their baseline creatinine (Cr). We tested the efficacy of N-acetylcysteine (NAC) relative to hydration in unselected patients (irrespective of baseline Cr) with DM.
We conducted a randomized open-label study comparing hydration alone (combined oral and rapid intravenous hydration, n = 69) to NAC plus hydration (similar hydration protocol plus NAC 600 mg BID x 4 doses, n = 68) in diabetic patients (mean age 65 +/- 10 years, 65% men) undergoing elective coronary angiography. The primary end point was the mean change in serum Cr measured up to 96 hours postangiography.
Baseline Cr was 1.14 +/- 0.43 mg/dL (Cr > or = 1.3 mg/dL in 37 subjects). Baseline characteristics including blood urea nitrogen, Cr, and contrast volume were similar between the 2 groups. The mean Cr change in the NAC group was 0.14 +/- 0.47 versus 0.08 +/- 0.11 mg/dL in the hydration only group (P = NS). Contrast-associated nephropathy, defined as a > or = 0.5 mg/dL increase in Cr, was significantly more common in the NAC group, 9.2% versus 1.4%, P = .043. Similar results were found in the subgroup of participants with either an increased baseline serum Cr (> or = 1.3 mg/dL) or in those receiving high contrast volumes (> 100 mL).
N-Acetylcysteine provides no benefit over an aggressive hydration protocol in patients with DM undergoing coronary angiography.
糖尿病（DM）患者无论其基线肌酐（Cr）水平如何，发生造影剂相关性肾病的风险均会增加。我们在未选择的糖尿病患者（无论基线Cr水平如何）中测试了N-乙酰半胱氨酸（NAC）相对于水化治疗的疗效。
我们进行了一项随机开放标签研究，比较单纯水化治疗（口服与快速静脉水化联合，n = 69）与NAC加水化治疗（类似水化方案加NAC 600 mg，每日两次，共4剂，n = 68）在接受择期冠状动脉造影的糖尿病患者（平均年龄65±10岁，65%为男性）中的效果。主要终点是造影后96小时内测得的血清Cr平均变化。
基线Cr为1.14±0.43 mg/dL（37名受试者的Cr≥1.3 mg/dL）。两组之间包括血尿素氮、Cr和造影剂用量在内的基线特征相似。NAC组的Cr平均变化为0.14±0.47 mg/dL，而单纯水化治疗组为0.08±0.11 mg/dL（P =无统计学意义）。造影剂相关性肾病定义为Cr升高≥0.5 mg/dL，在NAC组中明显更常见，分别为9.2%和1.4%，P = 0.043。在基线血清Cr升高（≥1.3 mg/dL）或接受高造影剂用量（>100 mL）的参与者亚组中也发现了类似结果。
对于接受冠状动脉造影的糖尿病患者，N-乙酰半胱氨酸并不比积极的水化方案更具优势。
