乙酰半胱氨酸预防造影剂肾病疗效的荟萃分析

Meta-analysis of N-acetylcysteine on prevention of contrast-induced nephropathy

目的系统评价乙酰半胱氨酸（NAC）对造影剂肾病的预防疗效。方法按循证医学的要求，制定相应的纳入标准、排除标准及检索策略，检索PubMed、Cochrane Library、Wiley Online Library、Google Scholar电子数据库，检索时限为2000年至2011年，获得NAC预防造影剂肾病的相关文献。由2位研究者根据纳入和排除标准独立选择符合标准的随机对照试验（RCT）并提取相关数据。采用RevMan5．1软件进行荟萃分析。结果初步检索出151篇相关文献，有16篇文献纳入本研究。16项研究共纳入4588例患者，14项试验的Jadad评分超过3分。16篇文献的整体荟萃分析结果显示，NAC可以预防造影剂肾病的发生（OR=0．65，95％CI 0．46～0．92，P=0．01）。患者平均Ser132．6μmol／L的11项研究荟萃分析结果显示，OR=0．52，95％CI 0．30～0．93，P=0．03，但患者平均Scr〈132．6μmol／L的6项研究荟萃分析结果显示，OR=0．93，95％CI 0．75～1．15，P=0．49。结论NAC对造影剂肾病的发生有一定的预防作用，当平均Scr≥132．6μmol／L时，NAC对造影剂肾病有明确的预防效果。

Objective To investigate the efficacy of N-acetylcysteine on prevention of contrast -induced nephropathy （CIN）. Methods According to the regulation of evidence-based medicine, the selection criteria, elimination criteria and search strategy were defined. PubMed, Cochrane Library, Wiley Online Library and Google Scholar were searched. The literature limited range was from January 2000 to December 2011. Two investigators extracted the data independently from all the studies that accorded with selection criteria using a suitable form. All the statistical analyses were performed with RevMan version 5.1. Results A total of 151 potential literatures were screened and 16 remained literatures （including 4588 patients） were identified to accord with the criteria in this meta-analysis. In 14 literatures, the Jadad score was 3 at least. The meta-analysis of 16 trials showed N-acetylcysteine could prevent CIN from happening [odds ratio （0R）=0.65,95% CI 0.46-0.92, P=0.01]. In the groups of average Scr baseline 〈 132.6 μmol/L, result displayed the OR of incidence associated with N- acetylcysteine for prevention of CIN was 0.93 （95% CI 0.75-1.15, P=0.49）. In the groups of average Scr baseline ≥ 132.6 p, mol/L, the OR for N-acetylcysteine associated with incidence of CIN was 0.52 （95% CI 0.30-0.93, P=0.03）. Conclusion There is specific effect that N-acetylcysteine prevents CIN from happening in the groups of average Scr baseline ≥ 132.6μ mol/L.