尼可地尔在预防接受心脏导管插入术患者的对比剂肾病中的作用：一项更新的系统评价和荟萃分析。
Role of nicorandil in preventing contrast-induced nephropathy in patients undergoing cardiac catheterization procedures: an updated systematic review and meta-analysis.
作者信息
Khan Ahmed Ali, Tahir Muhammad Zubair, Maryam Kanz Ul Eman, Uzair Muhammad, Faheem Muhammad Shaheer Bin, Abdullah Amna, Anwer Ahmed, Ashraf Danish Ali, Ahmed Amna Kaleem, Rahim Sidrah, Arshad Muhammad Sameer
机构信息
Department of Internal Medicine, Foundation University Medical College Islamabad, Islamabad, Pakistan.
Department of Internal Medicine, Punjab Medical College, Faisalabad, Pakistan.
出版信息
Int Urol Nephrol. 2025 May 4. doi: 10.1007/s11255-025-04542-x.
BACKGROUND
Contrast-induced nephropathy (CIN) is a major risk for patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI).
METHODS
PubMed, MEDLINE, Embase, Google Scholar, and Web of Science were searched through May 2024 to include randomized controlled trials (RCTs) assessing the efficacy and safety of nicorandil administration in patients following CAG or PCI. Outcomes of interest included the CIN incidence, major adverse events, serum creatinine, serum cystatin C, BUN and eGFR. Risk ratios (RRs) and standard mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects model. Statistical heterogeneity was assessed using I2 statistics.
RESULTS
Twelve studies (n = 2931 patients) were included in the final analysis. Nicorandil significantly reduced the CIN incidence (RR: 0.40 [0.31,0.52]; p < 0.00001), with consistent results for oral (RR: 0.35 [0.25,0.48]; p < 0.00001) and intravenous administration (RR: 0.52 [0.30,0.92]; p = 0.02) (p-interaction = 0.22). Oral nicorandil reduced the risk of major adverse events (RR: 0.71 [0.51,0.99]; p = 0.05). Among patients on nicorandil, serum creatinine levels were significantly lower at 48 h (SMD: -0.30 [-0.52,-0.07]; p = 0.009), and 72 h post-intervention (SMD: -0.42 [-0.71,-0.13]; p = 0.004). Nicorandil significantly reduced serum cystatin C levels at 48 h post-intervention (SMD: -0.56 [-1.01,-0.01]; p = 0.02). However, nicorandil did not significantly affect eGFR values at 24-h (SMD: 0.12 [-0.21,0.45]; p = 0.46), 48-h (SMD: 0.08 [-0.19,0.35]; p = 0.58), and 72-h (SMD: 0.34 [-0.13,0.81]; p = 0.16).
CONCLUSION
Nicorandil administration reduces the CIN incidence and improves renal biomarkers in patients undergoing CAG and PCI. Large-scale trials with longer follow-up periods are warranted to confirm renoprotective effects of nicorandil.
背景
造影剂肾病（CIN）是接受冠状动脉造影（CAG）和经皮冠状动脉介入治疗（PCI）患者的主要风险。
方法
检索截至2024年5月的PubMed、MEDLINE、Embase、谷歌学术和科学网，纳入评估尼可地尔在CAG或PCI术后患者中应用的疗效和安全性的随机对照试验（RCT）。感兴趣的结局包括CIN发生率、主要不良事件、血清肌酐、血清胱抑素C、血尿素氮和估算肾小球滤过率（eGFR）。采用随机效应模型计算风险比（RR）和95%置信区间（CI）的标准平均差（SMD）。使用I²统计量评估统计异质性。
结果
最终分析纳入12项研究（n = 2931例患者）。尼可地尔显著降低CIN发生率（RR：0.40 [0.31, 0.52]；p < 0.00001），口服（RR：0.35 [0.25, 0.48]；p < 0.00001）和静脉给药（RR：0.52 [0.30, 0.92]；p = 0.02）结果一致（p交互作用 = 0.22）。口服尼可地尔降低主要不良事件风险（RR：0.71 [0.51, 0.99]；p = 0.05）。在使用尼可地尔的患者中，干预后48小时血清肌酐水平显著降低（SMD：-0.30 [-0.52, -0.07]；p = 0.009），干预后72小时也显著降低（SMD：-0.42 [-0.71, -0.13]；p = 0.004）。尼可地尔在干预后48小时显著降低血清胱抑素C水平（SMD：-0.56 [-1.01, -0.01]；p = 0.02）。然而，尼可地尔在24小时（SMD：0.12 [-0.21, 0.45]；p = 0.46）、48小时（SMD：0.08 [-0.19, 0.35]；p = 0.58）和72小时（SMD：0.34 [-0.13, 0.81]；p = 0.16）时对eGFR值无显著影响。
结论
应用尼可地尔可降低接受CAG和PCI患者的CIN发生率并改善肾脏生物标志物。有必要进行更长随访期的大规模试验以证实尼可地尔的肾脏保护作用。
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