Wang Jing, Ai Xiaobo, Li Li, Gao Yanyan, Sun Nina, Li Changgui, Sun Weihong
The Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, 266100, China.
Department of Nephrology, Qingdao Fifth People's Hospital, Qingdao, 266000, China.
Int Urol Nephrol. 2017 Nov;49(11):2019-2026. doi: 10.1007/s11255-017-1639-2. Epub 2017 Jun 27.
Type 2 diabetes mellitus (T2DM) patients treated with metformin are predisposed to develop contrast-induced nephropathy (CIN) after received emergency contrast-enhanced computed tomography (CT) examination. We evaluated the protective effects of alprostadil on CIN in T2DM patients treated with metformin after contrast media (CM) administration.
In this single-institution, single-blind, superiority trial, we randomly assigned 451 T2DM patients taking metformin and underwent emergency contrast-enhanced CT examination to either the alprostadil group (227 patients) receiving alprostadil or the control group (224 patients) without alprostadil. All subjects stopped taking metformin and drank 500 ml water within 12 h after CM exposure. In addition, patients in the alprostadil group were injected with alprostadil (10 μg/day, for 3 days) plus 20 ml normal saline (alprostadil hydration) and the control group patients were daily injected with 20 ml normal saline as control for 3 days following CM administration. Serum creatinine (Scr) was measured before and <72 h after contrast-enhanced CT examination. CIN was defined as an increase in Scr ≥ 44.2 µmol/l (0.5 mg/dL) or >25% over baseline within 3 days of contrast administration.
There was a lower incidence of CIN in patients underwent alprostadil hydration than drinking water monohydration after CM administration, who with either normal renal function or chronic kidney disease (baseline eGFR < 60 ml·min·1.73 m).
Alprostadil hydration was superior to drinking water monohydration regarding preventing CIN in T2DM patients treated with metformin after contrast-enhanced CT.
接受急诊对比增强计算机断层扫描（CT）检查后，使用二甲双胍治疗的2型糖尿病（T2DM）患者易发生对比剂肾病（CIN）。我们评估了前列地尔对接受造影剂（CM）注射后的二甲双胍治疗的T2DM患者发生CIN的保护作用。
在这项单机构、单盲、优效性试验中，我们将451例正在服用二甲双胍并接受急诊对比增强CT检查的T2DM患者随机分为前列地尔组（227例患者）和对照组（224例患者），前列地尔组接受前列地尔治疗，对照组不接受前列地尔治疗。所有受试者在接触CM后12小时内停止服用二甲双胍并饮用500毫升水。此外，前列地尔组患者注射前列地尔（10μg/天，共3天）加20毫升生理盐水（前列地尔水化），对照组患者在CM给药后每天注射20毫升生理盐水作为对照，共3天。在对比增强CT检查前和检查后<72小时测量血清肌酐（Scr）。CIN定义为在造影剂给药后3天内Scr升高≥44.2μmol/l（0.5mg/dL）或超过基线水平>25%。
在CM给药后，接受前列地尔水化的患者中CIN的发生率低于单纯饮水水化的患者，无论其肾功能正常还是患有慢性肾脏病（基线估算肾小球滤过率[eGFR]<60ml·min·1.73m²）。
在接受对比增强CT检查后，对于使用二甲双胍治疗的T2DM患者，前列地尔水化在预防CIN方面优于单纯饮水水化。
