Kelly Aine M, Dwamena Ben, Cronin Paul, Bernstein Steven J, Carlos Ruth C
Department of Radiology, Division of Cardiothoracic Imaging, University of Michigan and Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan 48109, USA
Ann Intern Med. 2008 Feb 19;148(4):284-94. doi: 10.7326/0003-4819-148-4-200802190-00007.
N-Acetylcysteine, theophylline, and other agents have shown inconsistent results in reducing contrast-induced nephropathy.
To determine the effect of these agents on preventing nephropathy.
Relevant randomized, controlled trials were identified by computerized searches in MEDLINE (from 1966 through 3 November 2006), EMBASE (1980 through November 2006), PubMed, Web of Knowledge (Current Contents Connect, Web of Science, BIOSIS Previews, and ISI Proceedings for the latest 5 years), and the Cochrane Library databases (up to November 2006). Databases were searched for studies in English, Spanish, French, Italian, and German.
Randomized, controlled trials that administered N-acetylcysteine, theophylline, fenoldopam, dopamine, iloprost, statin, furosemide, or mannitol to a treatment group; used intravenous iodinated contrast; defined contrast-induced nephropathy explicitly; and reported sufficient data to construct a 2 x 2 table of the primary effect measure.
Abstracted information included patient characteristics, type of contrast media and dose, periprocedural hydration, definition of contrast-induced nephropathy, and prophylactic agent dose and route.
In the 41 studies included, N-acetylcysteine (relative risk, 0.62 [95% CI, 0.44 to 0.88]) and theophylline (relative risk, 0.49 [CI, 0.23 to 1.06]) reduced the risk for contrast-induced nephropathy more than saline alone, whereas furosemide increased it (relative risk, 3.27 [CI, 1.48 to 7.26]). The remaining agents did not significantly affect risk. Significant subgroup heterogeneity was present only for N-acetylcysteine. No publication bias was discerned.
All trials evaluated the surrogate end point of contrast-induced nephropathy as the primary outcome. The lack of a statistically significant renoprotective effect of theophylline may result from insufficient data or study heterogeneity. True study quality remains uncertain.
N-acetylcysteine is more renoprotective than hydration alone. Theophylline may also reduce risk for contrast-induced nephropathy, although the detected association was not significant. Our data support the administration of N-acetylcysteine prophylaxis, particularly in high-risk patients, given its low cost, availability, and few side effects.
N - 乙酰半胱氨酸、茶碱及其他药物在降低造影剂肾病方面的效果并不一致。
确定这些药物在预防肾病方面的作用。
通过计算机检索MEDLINE（1966年至2006年11月3日）、EMBASE（1980年至2006年11月）、PubMed、Web of Knowledge（当前内容连接、科学网、生物学文摘数据库以及最近5年的ISI会议录）和Cochrane图书馆数据库（截至2006年11月）来识别相关的随机对照试验。检索这些数据库中用英文、西班牙文、法文、意大利文和德文发表的研究。
将N - 乙酰半胱氨酸、茶碱、非诺多泮、多巴胺、伊洛前列素、他汀类药物、呋塞米或甘露醇给予治疗组的随机对照试验；使用静脉碘造影剂；明确界定造影剂肾病；并报告有足够数据以构建主要效应指标的2×2表格。
提取的信息包括患者特征、造影剂类型和剂量、围手术期水化、造影剂肾病的定义以及预防药物的剂量和给药途径。
在纳入的41项研究中，N - 乙酰半胱氨酸（相对危险度，0.62 [95%可信区间，0.44至0.88]）和茶碱（相对危险度，0.49 [可信区间，0.23至1.06]）比单独使用生理盐水更能降低造影剂肾病的风险，而呋塞米则增加了该风险（相对危险度，3.27 [可信区间，1.48至7.26]）。其余药物对风险无显著影响。仅N - 乙酰半胱氨酸存在显著的亚组异质性。未发现发表偏倚。
所有试验均将造影剂肾病的替代终点作为主要结局进行评估。茶碱缺乏统计学上显著的肾脏保护作用可能是由于数据不足或研究异质性所致。真正的研究质量仍不确定。
N - 乙酰半胱氨酸比单纯水化更具有肾脏保护作用。茶碱也可能降低造影剂肾病的风险，尽管所检测到的关联并不显著。鉴于其成本低、易于获得且副作用少，我们的数据支持给予N - 乙酰半胱氨酸进行预防，尤其是在高危患者中。
