Ibrahim Tarek A, El-Mawardy Ramzy H, El-Serafy Ahmed S, El-Fekky Ehab M
Cardiology Department, Ain Shams University, Cairo, Egypt.
Cardiology Department, Ain Shams University, Cairo, Egypt.
Cardiovasc Revasc Med. 2017 Jul-Aug;18(5):315-319. doi: 10.1016/j.carrev.2017.02.006. Epub 2017 Feb 10.
Contrast induced nephropathy (CIN) may be defined as Acute Renal Failure (ARF) that occurs within 24-72h of exposure to intra-venous or intra-arterial iodinated contrast media that cannot be attributed to other causes. CIN occurs in up to 5% of hospitalized patients with normal renal function prior to injection of contrast media. It occurs more frequently in patients with renal impairment particularly if associated with diabetic nephropathy. Among all procedures utilizing contrast agents for either diagnostic or therapeutic purposes, coronary angiography and percutaneous coronary interventions are associated with the highest rates of CIN. Trimetazidine has been described as a cellular anti-ischemic agent. Previous studies demonstrated that Trimetazidine prevents the deleterious effects of ischemia-reperfusion at both the cellular and mitochondrial levels and exerts an anti-oxidant effect. It inhibits excess release of oxygen free radicals, limits cellular acidosis, protects Adenosine Triphosphate (ATP) stores, reduces membrane lipid peroxidation and inhibits neutrophil infiltration.
To evaluate the role of Trimetazidine (TMZ) in prevention of contrast induced nephropathy (CIN) in patients with renal impairment undergoing coronary angiography.
This study was conducted on one hundred patients having a basal creatinine clearance below 90ml/min and presenting for coronary angiography procedures. The patients were divided into two equal groups each including fifty patients where both groups received parenteral hydration in the form of isotonic saline at a rate of 1mg/kg body weight per hour starting 12h before angiography and up to 12h thereafter. In Group 1, patients received additional medication in the form of trimetazidine 35mg twice daily for 72h and starting 48h before the procedure which was not received in group 2 (control). There was a significant difference regarding the rate of CIN among TMZ versus control groups (10% vs. 26%). The amount of contrast was significantly higher in the CIN group (165.00±108.41 vs 89.85±38.60, P=0.000).
Administration of trimetazidine in a dose of 35mg twice daily orally in conjunction with standard early saline hydration is an effective method to prevent or reduce the incidence of contrast-induced renal dysfunction following the administration of contrast media during coronary angiography procedures in patients with mild-moderate basal renal insufficiency.
对比剂肾病（CIN）可定义为在静脉或动脉注射碘化造影剂后24 - 72小时内发生的急性肾衰竭（ARF），且不能归因于其他原因。在注射造影剂前肾功能正常的住院患者中，CIN的发生率高达5%。在肾功能损害患者中更常见，尤其是合并糖尿病肾病时。在所有使用造影剂进行诊断或治疗的操作中，冠状动脉造影和经皮冠状动脉介入治疗与CIN的发生率最高相关。曲美他嗪被描述为一种细胞抗缺血药物。先前的研究表明，曲美他嗪在细胞和线粒体水平上均可预防缺血再灌注的有害影响，并发挥抗氧化作用。它抑制氧自由基的过度释放，限制细胞酸中毒，保护三磷酸腺苷（ATP）储备，减少膜脂质过氧化并抑制中性粒细胞浸润。
评估曲美他嗪（TMZ）在预防接受冠状动脉造影的肾功能损害患者发生对比剂肾病（CIN）中的作用。
本研究对100例基础肌酐清除率低于90ml/分钟且准备接受冠状动脉造影的患者进行。患者被分为两组，每组50例，两组均在血管造影前12小时开始，以每小时1mg/kg体重的等渗盐水形式进行静脉补液，持续至血管造影后12小时。在第1组中，患者在术前48小时开始额外接受曲美他嗪35mg每日两次，共72小时的药物治疗，第2组（对照组）未接受该治疗。TMZ组与对照组之间CIN的发生率存在显著差异（10%对26%）。CIN组的造影剂用量显著更高（165.00±108.41对89.85±38.60，P = 0.000）。
对于轻度至中度基础肾功能不全的患者，在冠状动脉造影过程中，每日两次口服35mg曲美他嗪并联合标准的早期盐水补液，是预防或降低造影剂所致肾功能不全发生率的有效方法。
