重症监护患者对比剂所致肾病的预防：乙酰半胱氨酸、茶碱，还是两者联用？一项随机研究。

Prophylaxis of contrast material-induced nephropathy in patients in intensive care: acetylcysteine, theophylline, or both? A randomized study.

作者信息

Huber Wolfgang, Eckel Florian, Hennig Michael, Rosenbrock Hilkea, Wacker Annette, Saur Dieter, Sennefelder Angelika, Hennico Romain, Schenk Cordula, Meining Alexander, Schmelz Renate, Fritsch Ralph, Weiss Wolfgang, Hamar Peter, Heemann Uwe, Schmid Roland M

机构信息

II. Medizinische Klinik, Institut für Medizinische Statistik und Epidemiologie, Universitaetsklinik Tuebingen, Kinderkardiologie, Munich, Germany.

出版信息

Radiology. 2006 Jun;239(3):793-804. doi: 10.1148/radiol.2393041456.

DOI:10.1148/radiol.2393041456

PMID:16714461

Abstract

PURPOSE

To prospectively compare the protective effect of acetylcysteine, theophylline, and both agents combined in patients who are admitted to the intensive care unit with at least one risk factor for contrast material-induced nephropathy and who receive at least 100 mL of iodinated contrast medium.

MATERIALS AND METHODS

Institutional ethics review board approval and informed consent were obtained. A total of 91 patients (mean age, 58.5 years+/-14.8 [standard deviation]; 31 women, 60 men; 150 examinations) were admitted to the intensive care unit with at least one risk factor for contrast-induced nephropathy and received either (a) 200 mg theophylline 30 minutes before contrast medium administration (group T), (b) 600 mg acetylcysteine twice daily on the day of and (if possible) the day before the examination (group A), or (c) both agents combined (group AT). The primary endpoint for this study was the incidence of contrast-induced nephropathy (chi2 test).

RESULTS

Groups T, A, and AT were comparable with regard to baseline creatinine levels and the amount of contrast medium administered. The incidence of contrast-induced nephropathy in groups T, A, and AT was 2%, 12%, and 4%, respectively, and was significantly lower in group T than in group A (P=.047). There was no significant difference in the incidence of contrast-induced nephropathy between groups A and AT (P=.148) or between groups T and AT (P=.53). For group A, serum creatinine did not change after 12, 24, or 48 hours compared with baseline. Creatinine levels in group T decreased 12 hours (1.19 mg/dL+/-0.58; P=.008) and 48 hours (1.16 mg/dL+/-0.55; P=.034) after contrast material injection compared with baseline (1.25 mg/dL+/-0.61). In group AT, creatinine significantly decreased 24 hours (1.21 mg/dL+/-0.74; P=.003) and 48 hours (1.17 mg/dL+/-0.69; P<.001) after contrast material injection compared with baseline (1.28 mg/dL+/-0.74). Group A had significantly higher maximal increases in creatinine than groups T and AT (P=.014).

CONCLUSION

For prophylaxis of contrast-induced nephropathy in patients who are admitted to the intensive care unit and who receive 100 mL or more of contrast medium, theophylline is superior to acetylcysteine.

摘要

目的

前瞻性比较乙酰半胱氨酸、茶碱以及二者联合应用对入住重症监护病房且至少有一项造影剂肾病危险因素并接受至少100 mL碘化造影剂的患者的保护作用。

材料与方法

获得机构伦理审查委员会批准并取得知情同意。共有91例患者（平均年龄58.5岁±14.8[标准差]；女性31例，男性60例；150次检查）入住重症监护病房，至少有一项造影剂肾病危险因素，并接受以下治疗之一：（a）造影剂注射前30分钟给予200 mg茶碱（T组）；（b）检查当天及（如有可能）检查前一天每天两次给予600 mg乙酰半胱氨酸（A组）；或（c）二者联合应用（AT组）。本研究的主要终点是造影剂肾病的发生率（卡方检验）。

结果

T组、A组和AT组在基线肌酐水平和造影剂用量方面具有可比性。T组、A组和AT组造影剂肾病的发生率分别为2%、12%和4%，T组显著低于A组（P = 0.047）。A组与AT组之间（P = 0.148）以及T组与AT组之间（P = 0.53）造影剂肾病的发生率无显著差异。对于A组，血清肌酐在12、24或48小时后与基线相比无变化。与基线（1.25 mg/dL±0.61）相比，T组肌酐水平在造影剂注射后12小时（1.19 mg/dL±0.58；P = 0.008）和48小时（1.16 mg/dL±0.55；P = 0.034）下降。在AT组，与基线（1.28 mg/dL±0.74）相比，造影剂注射后24小时（1.21 mg/dL±0.74；P = 0.003）和48小时（1.17 mg/dL±0.69；P<0.001）肌酐显著下降。A组肌酐的最大升高幅度显著高于T组和AT组（P = 0.014）。