Tasanarong Adis, Piyayotai Dilok, Thitiarchakul Supachai
Nephrology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, Pathumtani, Thailand.
J Med Assoc Thai. 2009 Oct;92(10):1273-81.
Contrast-induced nephropathy (CIN) increases the likelihood of patient morbidity and mortality following coronary procedures. Contrast agents cause an acute deterioration in renal function via the generation of reactive oxygen species. The present study was designed to evaluate the administration of antioxidant vitamin E (alpha tocopherol) as a means of preventing CIN in these patients.
The authors conducted a prospective, double-blind, randomized and placebo-controlled trial in 103 patients with serum creatinine (SCr) levels > or = 1.2 mg/dL, baseline creatinine clearance levels < or = 60 mL/min, and who had undergone coronary procedures. Alpha tocopherol (525 IU) or a placebo compound was administered orally at 48 hr, 24 hr, and in the morning prior to coronary procedures.
CIN developed in 3 of 51 patients (5.88%) in the alpha tocopherol group and 12 of 52 patients (23.08%) in the placebo group (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.05 to 0.79; p = 0.02). The mean SCr increased significantly in the placebo group (from 1.67 +/- 0.53 to 1.9 +/- 0.87 mg/dL, p = 0.02) but not in the alpha tocopherol group (from 1.62 +/- 0.44 to 1.64 +/- 0.59 mg/dL, p = 0.74). Patients with diabetes, anemia, or with contrast agent dosages greater than 120 ml exhibited significantly lower incidences of CIN development in the alpha tocopherol group than the placebo group (p < 0.05).
Prophylactic oral administration of alpha tocopherol is capable of protecting against CIN in patients with chronic kidney disease undergoing elective coronary procedures.
造影剂肾病（CIN）增加了冠状动脉手术后患者发病和死亡的可能性。造影剂通过产生活性氧导致肾功能急性恶化。本研究旨在评估给予抗氧化剂维生素E（α-生育酚）作为预防这些患者发生CIN的一种方法。
作者对103例血清肌酐（SCr）水平≥1.2mg/dL、基线肌酐清除率≤60mL/min且接受过冠状动脉手术的患者进行了一项前瞻性、双盲、随机和安慰剂对照试验。在冠状动脉手术前48小时、24小时及早晨口服α-生育酚（525IU）或安慰剂。
α-生育酚组51例患者中有3例（5.88%）发生CIN，安慰剂组52例患者中有12例（23.08%）发生CIN（优势比[OR]，0.21；95%置信区间[CI]，0.05至0.79；p = 0.02）。安慰剂组的平均SCr显著升高（从1.67±0.53mg/dL升至1.9±0.87mg/dL，p = 0.02），而α-生育酚组则未升高（从1.62±0.44mg/dL升至1.64±0.59mg/dL，p = 0.74）。糖尿病、贫血或造影剂剂量大于120ml的患者，α-生育酚组CIN的发生率显著低于安慰剂组（p < 0.05）。
对接受择期冠状动脉手术的慢性肾病患者预防性口服α-生育酚能够预防CIN。
