Department of Nephrology, the 306th Hospital of Chinese PLA, 9 AnXiangBeiLi Road, Beijing, 100101, China.
Department of Nephrology, The Hospital of Shunyi District Beijing, No.3 Guangming South Street, Shunyi District, Beijing, China.
Am J Cardiovasc Drugs. 2018 Oct;18(5):373-386. doi: 10.1007/s40256-018-0274-3.
To date, universally accepted preventive measures for contrast-induced acute kidney injury (CI-AKI) do not exist, and they warrant further research.
The purpose of this study was to evaluate the efficacy of vitamins, including vitamin C and E, for prevention of CI-AKI.
We electronically searched the MEDLINE, EMBASE, and Cochrane databases. The outcome of interest was the incidence of CI-AKI.
A total of 19 studies were included in this meta-analysis. Pooled analysis showed that vitamin C plus saline [relative risk (RR) = 0.63, 95% confidence interval (CI) 0.49-0.82, p = 0.0005] and vitamin E plus saline (RR = 0.39, 95% CI 0.24-0.62, p < 0.0001) significantly reduced the incidence of CI-AKI compared to saline alone. The effect of vitamin C plus saline was further confirmed by trial sequential analysis (TSA). However, TSA indicated that more trials are required to confirm the efficacy of vitamin E plus saline. There was no significant difference in preventing CI-AKI between vitamin C and N-acetylcysteine (NAC) (RR = 0.90, 95% CI 0.47-1.71, p = 0.75), between vitamin C plus NAC and saline (RR = 0.62, 95% CI 0.30-1.30, p = 0.20), as well as between vitamin C plus NAC and NAC (RR = 0.97, 95% CI 0.49-1.92, p = 0.93).
Vitamin C plus saline administration is effective at reducing the risk of CI-AKI. Evidence for the use of vitamin E plus saline in this context is encouraging, but more trials are required. Furthermore, this meta-analysis and TSA indicated insufficient power to draw a definitive conclusion on the effect of vitamin C plus NAC, versus saline or NAC alone, which needs to be explored further.
目前，尚无被普遍认可的预防对比剂诱导急性肾损伤（CI-AKI）的措施，因此需要进一步研究。
本研究旨在评估维生素（包括维生素 C 和 E）预防 CI-AKI 的效果。
我们对 MEDLINE、EMBASE 和 Cochrane 数据库进行了电子检索。主要结局指标为 CI-AKI 的发生率。
共有 19 项研究纳入本荟萃分析。汇总分析显示，维生素 C 联合生理盐水[相对风险（RR）=0.63，95%置信区间（CI）0.49-0.82，p=0.0005]和维生素 E 联合生理盐水（RR=0.39，95%CI 0.24-0.62，p<0.0001）与单独使用生理盐水相比，CI-AKI 的发生率显著降低。试验序贯分析（TSA）进一步证实了维生素 C 联合生理盐水的效果。但是，TSA 提示需要更多的试验来证实维生素 E 联合生理盐水的疗效。维生素 C 与 N-乙酰半胱氨酸（NAC）（RR=0.90，95%CI 0.47-1.71，p=0.75）、维生素 C 联合 NAC 与生理盐水（RR=0.62，95%CI 0.30-1.30，p=0.20）以及维生素 C 联合 NAC 与 NAC（RR=0.97，95%CI 0.49-1.92，p=0.93）预防 CI-AKI 的效果无显著差异。
给予维生素 C 联合生理盐水可降低 CI-AKI 的风险。在这种情况下，使用维生素 E 联合生理盐水的证据令人鼓舞，但还需要更多的试验。此外，本荟萃分析和 TSA 提示，目前尚无法确定维生素 C 联合 NAC 与单独使用生理盐水或 NAC 相比的效果，需要进一步探讨。
