Mainra Rahul, Gallo Kerri, Moist Louise
Schulich School of Medicine and Dentistry, University of Western Ontario, and London Health Sciences Center, London, Ontario, Canada.
Nephrology (Carlton). 2007 Oct;12(5):510-3. doi: 10.1111/j.1440-1797.2007.00833.x.
N-acetylcysteine (NAC) is commonly administered to high-risk individuals to attenuate the risk of contrast-induced nephropathy in spite of the debate regarding its efficacy. In several studies serum creatinine decreased after exposure to NAC and contrast dye. The mechanism by which NAC attenuates the decline in renal function is not known. Studies in subjects with normal renal function suggest NAC may have an effect on tubular secretion.
The aim of this study was to determine the effect of NAC on renal function, measured by serum creatinine and Cystatin C, in patients with stage 3 chronic kidney disease.
Serum creatinine and Cystatin C were measured prior to, 4, 24 and 48 h after the administration of 600 mg oral NAC in 30 patients. The protocol was repeated with the addition of 1200 mg oral cimetidine administered 3 h before NAC.
Serum creatinine was not significantly different from baseline (186 +/- 65 micromol/L) to 4 h (185 +/- 62 micromol/L), 24 h (187 +/- 64 micromol/L) or 48 h (184 +/- 61 micromol/L) post NAC, nor were Cystatin C levels. Co-administration of cimetidine resulted in a significant rise in serum creatinine with no change in Cystatin C levels.
This study failed to detect a change in serum creatinine or Cystatin C after a single dose of NAC in participants with stage 3 chronic kidney disease. Further randomized trials of multiple doses and longer follow up are needed to confirm these results.
尽管关于N-乙酰半胱氨酸（NAC）的疗效存在争议，但它仍常用于高危个体以降低造影剂肾病的风险。在多项研究中，接触NAC和造影剂后血清肌酐水平下降。NAC减轻肾功能下降的机制尚不清楚。对肾功能正常的受试者的研究表明，NAC可能对肾小管分泌有影响。
本研究旨在确定NAC对3期慢性肾脏病患者肾功能的影响，通过血清肌酐和胱抑素C进行测量。
对30例患者口服600mg NAC前、用药后4小时、24小时和48小时测量血清肌酐和胱抑素C。在NAC给药前3小时加用1200mg口服西咪替丁，重复该方案。
NAC给药后4小时（185±62μmol/L）、24小时（187±64μmol/L）或48小时（184±61μmol/L），血清肌酐与基线水平（186±65μmol/L）相比无显著差异，胱抑素C水平也无差异。联合使用西咪替丁导致血清肌酐显著升高，而胱抑素C水平无变化。
本研究未能检测到3期慢性肾脏病参与者单次服用NAC后血清肌酐或胱抑素C的变化。需要进一步进行多剂量和更长随访时间的随机试验来证实这些结果。
