Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
J Interv Cardiol. 2013 Feb;26(1):90-6. doi: 10.1111/j.1540-8183.2012.00767.x. Epub 2012 Sep 20.
Antioxidant drugs such as N-acetylcysteine (NAC) and ascorbic acid have been evaluated in interventional studies to prevent contrast-induced nephropathy (CIN), however, there are limited data on comparing either or both, with background of standard intravenous saline hydration versus the standard intravenous saline hydration alone in preventing CIN.
We conducted a single-center randomized trial among patients undergoing coronary angiography or percutaneous coronary intervention who had serum creatinine ≥ 1.3 mg/dL or were on diabetes mellitus medication. Eligible patients were randomly assigned to one of the following 4 groups: (1) NAC, (2) ascorbic acid, (3) combination of both drugs, and (4) control group. Additionally, all the groups received the standard intravenous saline hydration. Creatinine was measured 4-5 days after procedure.
A total of 243 patients were randomized; 62 to NAC, 57 to ascorbic acid, 58 to both drugs, and 66 to placebo. The development of 0.5 mg/dL absolute increase of serum creatinine, 25% relative decrease of creatinine clearance, or either (CIN) were measured in the ascorbic acid group (3.6% for all), NAC group (6.8%, 3.4%, 8.5%, respectively), combined group (5.5%, 5.5%, 9.1%, respectively), and control group (6.2%, 6.2%, 7.7%, respectively). None of these differences were significant (P = 0.896 for serum creatinine, P = 0.863 for creatinine clearance, and P = 0.684 for CIN).
In a cohort of patients at risk of developing CIN, we could not detect any significant benefit of the use of ascorbic acid, NAC, or a combination of both drugs over the standard hydration regimen in preventing CIN.
抗氧化药物，如 N-乙酰半胱氨酸（NAC）和抗坏血酸，已在介入研究中评估用于预防对比剂肾病（CIN），然而，在比较任何一种或两种药物与标准静脉生理盐水水化单独用于预防 CIN 方面，数据有限。
我们在接受冠状动脉造影或经皮冠状动脉介入治疗的患者中进行了一项单中心随机试验，这些患者的血清肌酐≥1.3mg/dL 或正在服用糖尿病药物。符合条件的患者被随机分配到以下 4 组之一：（1）NAC，（2）抗坏血酸，（3）两种药物的联合用药，和（4）对照组。此外，所有组均接受标准静脉生理盐水水化。术后 4-5 天测量肌酐。
共有 243 名患者被随机分组；NAC 组 62 例，抗坏血酸组 57 例，联合用药组 58 例，安慰剂组 66 例。测量抗坏血酸组（所有患者的 3.6%）、NAC 组（6.8%、3.4%、8.5%）、联合用药组（5.5%、5.5%、9.1%）和对照组（6.2%、6.2%、7.7%）血清肌酐绝对值增加 0.5mg/dL、肌酐清除率相对下降 25%或其中任何一种（CIN）的发生率。这些差异均无统计学意义（血清肌酐 P=0.896，肌酐清除率 P=0.863，CIN P=0.684）。
在一组有发生 CIN 风险的患者中，我们无法发现使用抗坏血酸、NAC 或两者联合用药与标准水化方案相比在预防 CIN 方面有任何显著获益。
