Service de réanimation médicale, APHP-Groupe Hospitalier Henri Mondor, Créteil, France.
J Crit Care. 2013 Oct;28(5):701-9. doi: 10.1016/j.jcrc.2013.03.007. Epub 2013 May 15.
The use of N-acetylcysteine (NAC) for preventing contrast induced nephropathy (CIN) is debated in the intensive care unit. NAC may alter the concentration of serum creatinine and interfere with CIN diagnosis. The effectiveness of NAC was evaluated with a special attention on its specific effect on creatinine levels compared to cystatin C.
In a first period, we prospectively enrolled patients receiving saline and low osmolality contrast media for 140 exams in 2 intensive care units with opposite policies regarding the use of NAC. Renal impairment was defined by both the classical CIN and the "sensitive" Acute Kidney Injury Network (AKIN) (taking creatinine and diuresis) definitions. In a second period, we compared the evolution of serum creatinine and cystatin C after 23 additional contrast examinations under NAC.
Seventy exams with and without NAC were compared in the first period. Risk factors for CIN were similar in the two intensive care unit populations. No difference in CIN incidence was found with and without NAC, using the CIN (10/70 vs 15/70) or the AKIN (24/70 vs 22/70) definition. Interestingly, NAC seemed to reduce renal impairment when the creatinine criterion of the AKIN definition was considered alone [9% vs 21%, P=.033]. Overall, the incidence of renal impairment was 18%, 33% and 15% using the CIN definition, the AKIN, or using AKIN with creatinine alone. Serum creatinine significantly decreased after exams with NAC while cystatin C remained stable.
The incidence of CIN does not seem to be influenced by NAC, except if small changes in creatinine only are considered.
在重症监护病房中，关于使用 N-乙酰半胱氨酸（NAC）预防对比剂诱导的肾病（CIN）存在争议。NAC 可能会改变血清肌酐的浓度，并干扰 CIN 的诊断。本研究评估了 NAC 的疗效，并特别关注其与胱抑素 C 相比对肌酐水平的具体影响。
在第一阶段，我们前瞻性地招募了在 2 个重症监护病房接受生理盐水和低渗性对比剂的患者，这 2 个病房在使用 NAC 方面有相反的政策。肾损伤的定义是根据经典的 CIN 和“敏感”急性肾损伤网络（AKIN）（考虑肌酐和尿量）定义。在第二阶段，我们比较了在 NAC 下进行的 23 次额外的对比检查后血清肌酐和胱抑素 C 的变化。
在第一阶段比较了 70 次有和没有 NAC 的检查。两个重症监护病房人群的 CIN 危险因素相似。在有和没有 NAC 的情况下，使用 CIN（10/70 与 15/70）或 AKIN（24/70 与 22/70）定义，CIN 的发生率没有差异。有趣的是，当单独考虑 AKIN 定义的肌酐标准时，NAC 似乎降低了肾损伤的发生率[9%与 21%，P=0.033]。总体而言，使用 CIN 定义、AKIN 或 AKIN 加肌酐时，肾损伤的发生率分别为 18%、33%和 15%。使用 NAC 后，血清肌酐显著降低，而胱抑素 C 保持稳定。
除了仅考虑肌酐的微小变化外，NAC 似乎不会影响 CIN 的发生率。
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