Liu Jinming, Xie Yanan, He Fang, Gao Zihan, Hao Yuming, Zu Xiuguang, Chang Liang, Li Yongjun
Department of Cardiology, Second Hospital, Hebei Medical University, Shijiazhuang, Hebei 050000, China.
Department of Cardiology, Weixian Hospital of Traditional Chinese Medicine, Xingtai, Hebei 054700, China.
Biomed Res Int. 2016;2016:5985327. doi: 10.1155/2016/5985327. Epub 2016 Feb 2.
The role of brain natriuretic peptide (BNP) in the prevention of contrast-induced nephropathy (CIN) is unknown. This study aimed to investigate BNP's effect on CIN in chronic kidney disease (CKD) patients undergoing elective percutaneous coronary intervention (PCI) or coronary angiography (CAG). The patients were randomized to BNP (0.005 μg/kg/min before contrast media (CM) exposure and saline hydration, n = 106) or saline hydration alone (n = 103). Cystatin C, serum creatinine (SCr) levels, and estimated glomerular filtration rates (eGFR) were assessed at several time points. The primary endpoint was CIN incidence; secondary endpoint included changes in cystatin C, SCr, and eGFR. CIN incidence was significantly lower in the BNP group compared to controls (6.6% versus 16.5%, P = 0.025). In addition, a more significant deterioration of eGFR, cystatin C, and SCr from 48 h to 1 week (P < 0.05) was observed in controls compared to the BNP group. Although eGFR gradually deteriorated in both groups, a faster recovery was achieved in the BNP group. Multivariate logistic regression revealed that using >100 mL of CM (odds ratio: 4.36, P = 0.004) and BNP administration (odds ratio: 0.21, P = 0.006) were independently associated with CIN. Combined with hydration, exogenous BNP administration before CM effectively decreases CIN incidence in CKD patients.
脑钠肽（BNP）在预防造影剂肾病（CIN）中的作用尚不清楚。本研究旨在探讨BNP对接受择期经皮冠状动脉介入治疗（PCI）或冠状动脉造影（CAG）的慢性肾脏病（CKD）患者发生CIN的影响。患者被随机分为BNP组（造影剂暴露前以0.005μg/kg/min静脉输注BNP并给予生理盐水水化，n = 106）或单纯生理盐水水化组（n = 103）。在多个时间点评估胱抑素C、血清肌酐（SCr）水平及估算肾小球滤过率（eGFR）。主要终点为CIN发生率；次要终点包括胱抑素C、SCr及eGFR的变化。与对照组相比，BNP组的CIN发生率显著降低（6.6% 对16.5%，P = 0.025）。此外，与BNP组相比，对照组从48小时至1周eGFR、胱抑素C及SCr的恶化更显著（P < 0.05）。尽管两组的eGFR均逐渐恶化，但BNP组恢复更快。多因素logistic回归显示，使用>100 mL造影剂（比值比：4.36，P = 0.004）及给予BNP（比值比：0.21，P = 0.006）与CIN独立相关。在水化基础上，造影剂暴露前给予外源性BNP可有效降低CKD患者的CIN发生率。
