Baskent University Faculty of Medicine, Department of Cardiology, Adana, Turkey.
Int J Cardiol. 2013 Aug 20;167(4):1396-9. doi: 10.1016/j.ijcard.2012.04.068. Epub 2012 May 8.
Contrast-induced nephropathy (CIN) remains a common complication of radiographic procedures. Radiocontrast agents can cause a reduction in renal function that may be due to reactive oxygen species. Conflicting evidence suggests that administration of antioxidants prevents CIN.
We assessed the efficacy of allopurinol in preventing CIN. We prospectively randomized 159 patients with a serum creatinine concentration >1.1mg/dL undergoing cardiac catheterization/interventions to receive allopurinol (300 mg, p.o.) 24h before administration of radiocontrast agent and hydration (1mg/kg/hN/saline for 12h pre- and post-contrast, n=79), or hydration alone (1mg/kg/hN/saline for 12h pre- and post-contrast, n=80).
CIN occurred in 6 of 80 patients (7.5%) in the control group and no subjects in the allopurinol group (p=0.013). In the allopurinol group, median serum creatinine concentration decreased significantly from 1.43 mg/dL [1.1-4.15 mg/dL] to 1.35 mg/dL [0.7-4.15 mg/dl] at 48 h and to 1.27 mg/dL [0.66-4.37 mg/dL] at 4 days after radiocontrast administration (p<0.0001 and p<0.0001 compared with baseline, respectively). In the control group, median serum creatinine concentration decreased non-significantly from 1.48 mg/dL [1.1-2.96 mg/dL] to 1.43 mg/dL [0.73-3.02 mg/dL] and to 1.45 mg/dL [0.86-3.71 mg/dL] (p=0.045 and p=0.57, respectively) 48 h and 4 days after radiocontrast administration.
Prophylactic oral administration of allopurinol, along with hydration, may protect against CIN in high-risk patients undergoing coronary procedures.
对比剂肾病（CIN）仍然是放射学检查的常见并发症。放射造影剂会导致肾功能下降，这可能是由于活性氧所致。相互矛盾的证据表明，抗氧化剂的应用可以预防 CIN。
我们评估了别嘌醇预防 CIN 的疗效。我们前瞻性地将 159 例血清肌酐浓度>1.1mg/dL 的接受心脏导管检查/介入治疗的患者随机分为两组，一组接受别嘌醇（300mg，口服），在使用造影剂前 24 小时和造影后 12 小时给予水化（1mg/kg/hN/生理盐水）（n=79），另一组仅给予水化（1mg/kg/hN/生理盐水，造影前和造影后 12 小时）（n=80）。
对照组 80 例患者中有 6 例（7.5%）发生 CIN，而别嘌醇组无患者发生（p=0.013）。在别嘌醇组，血清肌酐浓度中位数在 48 小时时从 1.43mg/dL[1.1-4.15mg/dL]显著下降至 1.35mg/dL[0.7-4.15mg/dL]，在造影后 4 天下降至 1.27mg/dL[0.66-4.37mg/dL]（与基线相比，分别为 p<0.0001 和 p<0.0001）。在对照组，血清肌酐浓度中位数在 48 小时时从 1.48mg/dL[1.1-2.96mg/dL]非显著下降至 1.43mg/dL[0.73-3.02mg/dL]，在造影后 4 天下降至 1.45mg/dL[0.86-3.71mg/dL]（p=0.045 和 p=0.57）。
高危患者在接受冠状动脉介入治疗前，预防性口服别嘌醇联合水化治疗可能预防 CIN。
