Department of Cardiology, Shahid Rajaie Cardiovascular Medical and Research Hospital, P. O. Box: 13185-1678 Tehran, Iran.
Int Urol Nephrol. 2012 Aug;44(4):1145-9. doi: 10.1007/s11255-011-0053-4. Epub 2011 Sep 7.
Contrast-induced nephropathy (CIN) is an adverse consequence of contrast media use that results in significant morbidity and mortality and adds significant costs to diagnostic and interventional cardiology procedures. Various pathophysiological mechanisms have been proposed for CIN and various agents have been tested for its prevention. There is currently a general agreement that adequate pre-procedure hydration constitutes the cornerstone of prevention, yet there are reports of the use of some other agents with various efficacies. We prospectively tested pentoxifylline (PTX), an antioxidant, anti-inflammatory drug, for CIN prevention in patients undergoing coronary angioplasty.
In this prospective, randomized, single-blind, single-center clinical trial, 286 consecutive patients were randomly assigned to the control group (n = 146), with routine treatment and no PTX, or the study group (n = 140), with routine treatment and PTX, 400 mg/tid from 24 h before to 24 h after coronary angioplasty. Serum creatinine was measured before and 2 days after the procedure. The primary end point was the occurrence of CIN within 48 h.
The control and PTX groups were comparable in the overall predicted risk of CIN. Also, the type and volume of the contrast agent were not significantly different between the two groups. Following angioplasty, CIN occurred in 20 (13.69%) patients in the control group and in 12 (8.5%) patients in the study group; the difference was not statistically significant (P = 0.17). Additionally, there was no mortality and need for hemodialysis in either group.
In angioplasty patients, the prophylactic oral use of PTX could be recommended for CIN prevention, although no statistically significant protective effect was documented.
对比剂肾病（CIN）是对比剂使用的一种不良后果，可导致显著的发病率和死亡率，并增加诊断和介入心脏病学程序的成本。已经提出了各种病理生理学机制来解释 CIN，并且已经测试了各种药物来预防 CIN。目前普遍认为，充分的术前水化是预防的基石，但也有报告称使用了一些其他具有不同疗效的药物。我们前瞻性地测试了己酮可可碱（PTX），一种抗氧化剂、抗炎药物，用于预防接受冠状动脉成形术的患者的 CIN。
在这项前瞻性、随机、单盲、单中心临床试验中，286 例连续患者被随机分为对照组（n = 146），给予常规治疗且无 PTX，或研究组（n = 140），给予常规治疗和 PTX，从冠状动脉成形术前 24 小时至术后 24 小时每天 400 毫克 tid。在术前和术后 2 天测量血清肌酐。主要终点是在 48 小时内发生 CIN。
对照组和 PTX 组在 CIN 的总体预测风险方面具有可比性。此外，两组之间造影剂的类型和体积没有显著差异。经皮冠状动脉成形术后，对照组有 20 例（13.69%）患者发生 CIN，研究组有 12 例（8.5%）患者发生 CIN；差异无统计学意义（P = 0.17）。此外，两组均无死亡和需要血液透析。
在经皮冠状动脉成形术患者中，预防性口服 PTX 可推荐用于预防 CIN，尽管未记录到统计学上显著的保护作用。
