CNR Institute of Clinical Physiology, Massa and Pisa, Italy.
Int J Cardiol. 2012 Nov 15;161(2):93-6. doi: 10.1016/j.ijcard.2011.05.001. Epub 2011 May 24.
N-acetylcysteine (NAC) is considered a promising radio-protector for its antioxidant and anticarcinogenic properties. We examined the ability of NAC to confer protection against radiation-induced chromosomal DNA damage during cardiac catheterization procedures.
Sixty-five patients (52 males, age 64.4 ± 11.9 years) undergoing invasive cardiovascular procedures (peripheral transluminal angioplasty, n=45; cardiac resynchronization therapy, n=15 and ablation therapy n=5) were enrolled: 35 patients (26 males, age 63.4 ± 11.1 years) received the standard hydration protocol consisting of intravenous isotonic saline for 12h after catheterization (Group I), and 30 patients (26 males, age 65.5 ± 12.9 years) received a clinically driven double intravenous dose of NAC (6 mg/kg/h diluted in 250 mL of NaCl 0.9%) for 1h before and a standard dose (6 mg/kg/h diluted in 500 mL of NaCl 0.9%) for 12h following catheterization (Group II). Micronucleus assay (MN) was performed as biomarker of chromosomal DNA damage before, 2 and 24h after the radiation exposure. Dose-area product (DAP; Gy cm(2)) was assessed as physical measure of radiation load.
DAP was higher in NAC-treated patients (I=54.7 ± 23.6 vs II=126.2 ± 79.2 Gy cm(2), p=0.0001). MN frequency was 13.7 ± 4.7 ‰ at baseline and showed a significant rise at 2h (18.0 ± 6.8 p=0.01) and 24h (17.6 ± 5.9, p=0.03) in the Group I. There was no significant increase of MN in the Group II (13.7 ± 7.0, 15.5 ± 6.0 and 14.9 ± 6.3 for baseline, 2h and 24h respectively, p=0.4).
NAC treatment given to prevent contrast-induced nephropathy may also reduce DNA damage induced by ionizing radiation exposure during cardiac catheterization procedures.
N-乙酰半胱氨酸（NAC）因其抗氧化和抗癌特性，被认为是一种有前途的放射保护剂。我们研究了 NAC 保护心脏导管插入术过程中因辐射导致的染色体 DNA 损伤的能力。
共纳入 65 名（男 52 例，年龄 64.4±11.9 岁）接受介入心血管治疗的患者（外周经腔血管成形术 45 例，心脏再同步治疗 15 例，消融治疗 5 例）：35 例（男 26 例，年龄 63.4±11.1 岁）接受标准水化方案，即导管插入后 12 小时静脉滴注等渗生理盐水（I 组）；30 例（男 26 例，年龄 65.5±12.9 岁）在导管插入前 1 小时和插入后 12 小时内给予临床剂量双倍静脉滴注 NAC（6mg/kg/h，稀释于 250ml0.9%氯化钠中）（II 组）。在辐射暴露前后 2 和 24 小时进行微核试验（MN），作为染色体 DNA 损伤的生物标志物。剂量面积乘积（DAP；Gy cm(2)）作为辐射负荷的物理测量。
NAC 治疗组的 DAP 较高（I 组 54.7±23.6 与 II 组 126.2±79.2Gy cm(2)，p=0.0001）。MN 频率为 13.7±4.7‰，I 组在 2 小时（18.0±6.8，p=0.01）和 24 小时（17.6±5.9，p=0.03）时显著升高，而 II 组 MN 无显著增加（分别为 13.7±7.0、15.5±6.0 和 14.9±6.3，p=0.4）。
NAC 用于预防对比剂肾病的治疗，可能还会减少心脏导管插入术过程中因电离辐射引起的 DNA 损伤。
