Trivedi Hariprasad, Daram Sumanth, Szabo Aniko, Bartorelli Antonio L, Marenzi Giancarlo
Division of Nephrology and Kidney Disease Center, Medical College of Wisconsin, Milwaukee, USA.
Am J Med. 2009 Sep;122(9):874.e9-15. doi: 10.1016/j.amjmed.2009.01.035.
Whether N-acetylcysteine is beneficial for the prevention of contrast-induced nephropathy is uncertain.
We conducted a meta-analysis to evaluate the efficacy of high-dose N-acetylcysteine for the prevention of contrast-induced nephropathy. Our prespecified inclusion criteria were as follows: adult subjects; English language literature; administration of high-dose N-acetylcysteine a priori defined as a daily dose greater than 1200 mg or a single periprocedural dose (within 4 hours of contrast exposure) greater than 600 mg; prospective trials of individuals randomized to N-acetylcysteine, administered orally or intravenously, versus a control group; and trials that included the end point of the incidence of contrast-induced nephropathy. Trials that compared N-acetylcysteine with another active treatment were excluded.
Sixteen comparisons of patients randomized to high-dose N-acetylcysteine versus controls met our prespecified inclusion criteria with a total sample size of 1677 subjects (842 assigned to high-dose N-acetylcysteine and 835 assigned to the control arm). The average population age was 68 years, 38.7% were diabetic, and the majority was male (67.8% of reported instances). The weighted mean baseline creatinine of the overall population was 1.58 mg/dL. No significant heterogeneity was detected (P = .09; I(2) = 34%). The overall effect size assuming a common odds ratio revealed an odds ratio of 0.46 (95% confidence interval [CI], 0.33-0.63) for the occurrence of contrast-induced nephropathy with the use of high-dose N-acetylcysteine. The results of the more conservative random effects approach were similar (odds ratio = 0.52; 95% CI, 0.34-0.78). There was no evidence of publication bias (P = .34).
Our results suggest that high-dose N-acetylcysteine decreases the incidence of contrast-induced nephropathy.
N-乙酰半胱氨酸对预防造影剂肾病是否有益尚不确定。
我们进行了一项荟萃分析，以评估高剂量N-乙酰半胱氨酸预防造影剂肾病的疗效。我们预先设定的纳入标准如下：成年受试者；英文文献；高剂量N-乙酰半胱氨酸的给药，预先定义为每日剂量大于1200mg或单次围手术期剂量（在造影剂暴露后4小时内）大于600mg；对随机分配接受口服或静脉注射N-乙酰半胱氨酸的个体与对照组进行的前瞻性试验；以及包括造影剂肾病发生率终点的试验。比较N-乙酰半胱氨酸与另一种活性治疗的试验被排除。
16项将随机分配接受高剂量N-乙酰半胱氨酸与对照组的患者进行比较的研究符合我们预先设定的纳入标准，总样本量为1677名受试者（842名分配至高剂量N-乙酰半胱氨酸组，835名分配至对照组）。总体人群的平均年龄为68岁，38.7%为糖尿病患者，大多数为男性（报告病例的67.8%）。总体人群的加权平均基线肌酐为1.58mg/dL。未检测到显著异质性（P = 0.09；I² = 34%）。假设共同比值比的总体效应大小显示，使用高剂量N-乙酰半胱氨酸发生造影剂肾病的比值比为0.46（95%置信区间[CI]，0.33 - 0.63）。更保守的随机效应方法的结果相似（比值比 = 0.52；95% CI，0.34 - 0.78）。没有发表偏倚的证据（P = 0.34）。
我们的结果表明，高剂量N-乙酰半胱氨酸可降低造影剂肾病的发生率。
