Boscheri A, Weinbrenner C, Botzek B, Reynen K, Kuhlisch E, Strasser R H
Department of Internal Medicine and Cardiology, University of Technology, Dresden, Germany.
Clin Nephrol. 2007 Nov;68(5):279-86. doi: 10.5414/cnp68279.
Contrast-media induced nephropathy (CIN) remains a common complication after contrast dye exposure especially in patients with chronic renal impairment (CRI). We sought to evaluate the efficacy of the antioxidant ascorbic acid as an adjunct to hydration in limiting the incidence of contrast induced nephrotoxicity after coronary procedures.
In a randomized, double-blind, prospective, single center-study, 143 consecutive patients with CRI (creatinine level > 120 micromol/l) referred to coronary angiography/intervention were randomly assigned to receive 1 g ascorbic acid or placebo in adjunct to saline hydration prior to and after angiography. Creatinine and urea nitrogen levels were measured prior to and up to 6 days after exposure to contrast agent.
The development of CIN occurred totally in 8/143 (5.6%) patients. Between the two groups no significant difference was detected (Vitamin C 5/74 (6.8%) patients; placebo 3/69 (4.3%) patients). After adjusting for the amount of contrast dye, drug treatment, cardiovascular risk factors, ejection fraction, or sex, again no differences were detected. No patient required dialysis. More patients with diabetes had development of CIN (7/85; 8.2%) compared with nondiabetic patients (1/58; 1.7%), although not significant (p = 0.14). The incidence of CIN was elevated in patients with high amounts (> 140 ml) of contrast volume used (6/8).
Our study does not support the prophylactic use of ascorbic acid in patients with renal dysfunction exposed to contrast dye.
造影剂诱发的肾病（CIN）仍然是造影剂暴露后常见的并发症，尤其是在慢性肾功能损害（CRI）患者中。我们试图评估抗氧化剂抗坏血酸作为水合作用的辅助手段在限制冠状动脉手术后造影剂诱发肾毒性发生率方面的疗效。
在一项随机、双盲、前瞻性、单中心研究中，143例连续接受冠状动脉造影/介入治疗的CRI患者（肌酐水平>120微摩尔/升）在造影前后被随机分配接受1克抗坏血酸或安慰剂，并辅以生理盐水水合作用。在接触造影剂之前及之后长达6天测量肌酐和尿素氮水平。
143例患者中有8例（5.6%）发生了CIN。两组之间未检测到显著差异（维生素C组74例中有5例（6.8%）；安慰剂组69例中有3例（4.3%））。在调整造影剂用量、药物治疗、心血管危险因素、射血分数或性别后，仍未检测到差异。没有患者需要透析。糖尿病患者发生CIN的比例（85例中有7例；8.2%）高于非糖尿病患者（58例中有1例；1.7%），尽管差异不显著（p = 0.14）。使用大量（>140毫升）造影剂的患者CIN发生率升高（8例中有6例）。
我们的研究不支持对肾功能不全且接触造影剂的患者预防性使用抗坏血酸。
