Schmidt Paul, Pang Dorothy, Nykamp Diane, Knowlton Gregory, Jia Haomiao
Saint Joseph's Hospital of Atlanta, Atlanta, GA, USA.
Ann Pharmacother. 2007 Jan;41(1):46-50. doi: 10.1345/aph.1H354. Epub 2006 Dec 26.
Radiocontrast-induced nephropathy (RCIN) is thought to be caused by renal ischemia and direct toxic effects on renal tubular cells brought on by contrast media. The combination of N-acetylcysteine (NAC) and hydration fluids (NaCl 0.9% or 0.45%) has been shown to reduce these deleterious effects and is commonly given prior to coronary angiography. The use of bicarbonate as the hydration anion has been shown to confer additional RCIN protection compared with that of saline. However, limited data are available regarding whether sodium bicarbonate hydration, proven to be beneficial alone, can further improve outcomes when given with NAC.
To compare the incidence of RCIN in patients undergoing coronary angiography after pretreatment with NAC plus sodium bicarbonate hydration or NAC plus standard hydration (NaCl 0.9% or 0.45%).
A retrospective, single-center study evaluated 96 patients who underwent coronary angiography from January 2002 to December 2005. Data were collected through electronic chart reviews.
Forty-seven patients received NAC and sodium bicarbonate for hydration and 49 received NAC and standard hydration. Baseline characteristics between the 2 groups were similar. All patients received at least one 600 mg oral dose of NAC before angiography was performed. RCIN was defined as impairment of renal function occurring within 72 hours of administering contrast media, indicated by an absolute increase in the serum creatinine level of 0.5 mg/dL or more. A total of 12.2% of the patients receiving NAC and standard hydration developed RCIN, versus 14.9% of the patients in the NAC and sodium bicarbonate group (p = 0.713).
The addition of sodium bicarbonate to NAC does not appear to confer additional protection against the development of RCIN. Prospective, randomized, placebo-controlled trials are warranted to definitively determine how this combination compares with NAC and standard hydration in preventing RCIN.
造影剂诱导的肾病（RCIN）被认为是由肾缺血以及造影剂对肾小管细胞的直接毒性作用所致。已证实，N-乙酰半胱氨酸（NAC）与水化液（0.9%或0.45%的氯化钠溶液）联合使用可减轻这些有害影响，并且通常在冠状动脉造影术前使用。与生理盐水相比，使用碳酸氢盐作为水化阴离子已显示出对RCIN具有额外的保护作用。然而，关于已证实单独使用有益的碳酸氢钠水化，与NAC联合使用时是否能进一步改善预后的数据有限。
比较在接受冠状动脉造影的患者中，NAC加碳酸氢钠水化预处理与NAC加标准水化（0.9%或0.45%的氯化钠溶液）后RCIN的发生率。
一项回顾性单中心研究评估了2002年1月至2005年12月期间接受冠状动脉造影的96例患者。通过电子病历审查收集数据。
47例患者接受NAC和碳酸氢钠进行水化，49例患者接受NAC和标准水化。两组之间的基线特征相似。所有患者在进行血管造影前均接受了至少一次600毫克的口服NAC剂量。RCIN定义为在给予造影剂后72小时内发生的肾功能损害，表现为血清肌酐水平绝对升高0.5毫克/分升或更多。接受NAC和标准水化的患者中，共有12.2%发生了RCIN，而在NAC和碳酸氢钠组中这一比例为14.9%（p = 0.713）。
在NAC中添加碳酸氢钠似乎并未对RCIN的发生提供额外的保护作用。有必要进行前瞻性、随机、安慰剂对照试验，以明确确定这种联合用药与NAC和标准水化在预防RCIN方面的比较情况。
