尼可地尔预防接受心脏导管插入术患者造影剂肾病的系统评价和荟萃分析。
Nicorandil in preventing contrast-induced nephropathy in patients undergoing cardiac catheterization procedures: a systematic review and meta-analysis.
作者信息
Waseem Ramsha, Kumar Ajay, Kumari Simran, Kumar Sagar, Bai Deepa, Kumar Ganesh, Jabbar Maheen, Ashraf Taimoor, Nancy Fnu, Mariam Bibi, Dev Shah, Turesh Muskan, Yousuf Muhammad Hamza, Ejaz Umer, Jawad Sayed
机构信息
Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
Department of Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan.
出版信息
Ann Med Surg (Lond). 2025 Jul 2;87(9):5925-5935. doi: 10.1097/MS9.0000000000003487. eCollection 2025 Sep.
BACKGROUND
Contrast-induced nephropathy (CIN) remains a significant complication in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI).
METHODS
A comprehensive literature search was conducted across PubMed, MEDLINE, Embase, Google Scholar, and Web of Science up to May 2024 to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of nicorandil in patients undergoing CAG or PCI. The primary outcome was CIN incidence, while secondary outcomes included, changes in serum creatinine, serum cystatin C, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR). Risk ratios (RRs) and standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I statistic.
RESULTS
Eleven RCTs and one prospective cohort study involving 2910 patients were included. Nicorandil administration was associated with a significant reduction in CIN incidence (RR: 0.40 [0.31-0.52], < 0.00001), with both oral (RR: 0.35 [0.25-0.48], < 0.00001) and intravenous formulations (RR: 0.52 [0.30-0.92], = 0.02) demonstrating efficacy (p-interaction = 0.22). Patients receiving nicorandil exhibited significantly lower serum creatinine levels at 48 hours (SMD: -0.34 [-0.52, -0.16], = 0.0002) and 72 hours (SMD: -0.24 [-0.40, -0.08], = 0.003) post-procedure. Serum cystatin C was also significantly reduced at 48 hours (SMD: -0.48 [-0.81, -0.15], = 0.004). However, nicorandil did not produce a significant change in eGFR at 24 hours (SMD: 0.17 [-0.07, 0.41], = 0.17), 48 hours (SMD: 0.13 [-0.10, 0.37], = 0.26), or 72 hours (SMD: 0.19 [-0.07, 0.45], = 0.36).
CONCLUSION
Nicorandil administration reduces CIN incidence and improves renal biomarker profiles in patients undergoing CAG and PCI. Further large-scale trials are necessary to validate its renoprotective properties.
背景
造影剂肾病（CIN）仍是接受冠状动脉造影（CAG）和经皮冠状动脉介入治疗（PCI）患者的一项重大并发症。
方法
截至2024年5月，在PubMed、MEDLINE、Embase、谷歌学术和科学网进行了全面的文献检索，以确定评估尼可地尔在接受CAG或PCI患者中的疗效和安全性的随机对照试验（RCT）。主要结局是CIN发生率，次要结局包括血清肌酐、血清胱抑素C、血尿素氮（BUN）和估计肾小球滤过率（eGFR）的变化。使用随机效应模型汇总风险比（RRs）和标准化均数差（SMDs）及其相应的95%置信区间（CIs）。使用I统计量评估异质性。
结果
纳入了11项RCT和1项前瞻性队列研究，涉及2910例患者。使用尼可地尔与CIN发生率显著降低相关（RR：0.40[0.31 - 0.52]，P < 0.00001），口服制剂（RR：0.35[0.25 - 0.48]，P < 0.00001）和静脉制剂（RR：0.52[0.30 - 0.92]，P = 0.02）均显示出疗效（P交互作用 = 0.22）。接受尼可地尔治疗的患者在术后48小时（SMD： - 0.34[-0.52, - 0.16]，P = 0.0002）和72小时（SMD： - 0.24[-0.40, - 0.08]，P = 0.003）时血清肌酐水平显著降低。血清胱抑素C在48小时时也显著降低（SMD： - 0.48[-0.81, - 0.15]，P = 0.004）。然而，尼可地尔在24小时（SMD：0.17[-0.07, 0.41]，P = 0.17）、48小时（SMD：0.13[-0.10, 0.37]，P = 0.26）或72小时（SMD：0.19[-0.07, 0.45]，P = 0.36）时未使eGFR产生显著变化。
结论
使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指标。需要进一步的大规模试验来验证其肾脏保护特性。
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