Ramesh N, Pillai R K, Abraham T, Padmaja N P, Hameed S, Vijayaraghavan G
Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum.
J Assoc Physicians India. 2006 Jun;54:449-52.
The increasingly frequent use of contrast enhanced imaging for diagnosis or interventions in patients with CAD has generated concern about avoidance of contrast induced nephropathy (CIN). Reactive oxygen species have been shown to cause CIN.
Angiographic contrasts worsen the renal function in patients with renal failure. We studied the reno-protective action of the antioxidant N-Acetyl cysteine (NAC) in patients undergoing coronary procedures.
Retrospective analysis of 51 patients with elevated serum creatinine levels (> or = 15mg%) was done, 24 of whom received NAC prior to the procedure(NAC group) and 27 who did not (Non NAC group). NAC was administered in a dose of 400 mg twice daily for four doses starting on the day prior to the procedure. Both groups of patients were hydrated with 0.45% saline at 1 ml/kg/hr for 12 hours prior to and 12 hours following the procedure. Both groups were comparable with regard to age, sex, coronary risk profile, myocardial infarction history, left ventricular function and the drugs received. Serum urea and creatinine were measured on the day prior to and the day following the angiographic procedure.
Nine out of 51 patients developed more than 0.5mg% rise in serum creatinine level; 1 in the NAC group and 8 in the non NAC group (p<0.05), 24 hours after injection of the contrast medium. In the NAC group mean serum creatinine level decreased from 1.94 +/- 0.56 to 1.67 +/- 0.56 and blood urea from 47.58 +/- 20 to 41.58 +/- 15.1. In the non NAC group serum creatinine increased from 1.75 +/- 0.31 to 1.98 +/- 0.56 and blood urea from 44.96 +/- 15.5 to 52.85 +/- 20.1 (p<0.05). This corresponds to an increase in creatinine clearance from 30ml/min to 35.92ml/min in the NAC group and a decrease from 34.42ml/min to 29.87ml/min in the non NAC group. There was no significant difference in the levels of sodium and potassium before and after the procedure in both the groups.
We conclude that prophylactit administration of N-Acetyl Cysteine along with hydration diminishes the incidence of deterioration of renal function induced by contrast agents in patients with renal insufficiency during coronary angiographic procedures.
在冠心病患者中，用于诊断或干预的增强造影成像使用日益频繁，这引发了对避免造影剂肾病（CIN）的关注。活性氧已被证明可导致造影剂肾病。
血管造影剂会使肾衰竭患者的肾功能恶化。我们研究了抗氧化剂N - 乙酰半胱氨酸（NAC）在接受冠状动脉手术患者中的肾脏保护作用。
对51例血清肌酐水平升高（≥15mg%）的患者进行回顾性分析，其中24例在手术前接受了NAC（NAC组），27例未接受（非NAC组）。从手术前一天开始，NAC以每日两次、每次400mg的剂量给药，共给药四次。两组患者在手术前12小时和手术后12小时均以1ml/kg/hr的速度输注0.45%盐水进行水化。两组在年龄、性别、冠状动脉风险特征、心肌梗死病史、左心室功能和所接受的药物方面具有可比性。在血管造影术前一天和术后一天测量血清尿素和肌酐。
51例患者中有9例血清肌酐水平升高超过0.5mg%；造影剂注射24小时后，NAC组1例，非NAC组8例（p<0.05）。NAC组平均血清肌酐水平从1.94±0.56降至1.67±0.56，血尿素从47.58±20降至41.58±15.1。非NAC组血清肌酐从1.75±0.31升至1.98±0.56，血尿素从44.96±15.5升至52.85±20.1（p<0.05）。这相当于NAC组肌酐清除率从30ml/min增至35.92ml/min，非NAC组从34.42ml/min降至29.87ml/min。两组手术前后钠和钾水平无显著差异。
我们得出结论，在冠状动脉造影术中，对肾功能不全患者预防性给予N - 乙酰半胱氨酸并进行水化，可降低造影剂所致肾功能恶化的发生率。
