N-乙酰半胱氨酸对老年冠心病患者介入治疗后造影剂肾病的预防作用

Preventive effect of N-acetylcysteine on contrast-induced nephropathy in elderly patients after percutaneous coronary intervention

目的探讨N-乙酰半胱氨酸(NAC)对老年冠心病患者PCI后造影剂肾病的预防作用。方法前瞻性入选天津市胸科医院心内科择期行PCI术的老年冠心病患者300例,按照随机数字表法分为NAC治疗组(NAC组)150例,常规治疗组(常规组)150例。其中NAC组给予NAC+水化治疗,常规组给予单纯水化治疗。观察2组患者PCI术前及术后72h血肌酐、肌酐清除率、尿素、β2微球蛋白(β2-MG)、C反应蛋白(CRP)、白细胞介素6(IL-6)、TNF-α、谷胱甘肽过氧化物酶(GPX)、超氧化物歧化酶(SOD)水平的变化,分析2组患者造影剂肾病发病情况。结果 NAC组与常规组PCI术后造影剂肾病发病率差异无统计学意义(P>0.05)。与术前比较,PCI术后72h,2组CRP、SOD、GPX水平明显升高(P<0.05),而2组血肌酐、肌酐清除率、尿素、IL-6、β2-MG比较,差异无统计学意义(P>0.05)。与常规组比较,PCI术后72h,NAC组SOD、GPX、CPR水平明显降低(P<0.01);而2组血肌酐、肌酐清除率、尿素、IL-6、β2-MG水平比较,差异无统计学意义(P>0.05)。结论 NAC对老年冠心病患者PCI术后造影剂肾病可能无预防作用。

Objective To study the preventive effect of N-acetylcysteine（NAC） on contrast-induced nephropathy in elderly patients with coronary heart disease（CHD） after percutaneous coronary intervention（PCI）. Methods Three hundred elderly CHD patients admitted to Tianjin Chest Hospital for PCI were randomly divided into NAC treatment group（n= 150）and conventional treatment group（n=150）. Patients in NAC treatment group received oral NAC＋hydration treat- ment and those in conventional treatment group received simple hydration treatment. Their serum levels of creatinine （Scr）, Scr clearance rate, urea nitrogen （BUN）, β2 microglobulin （β2-MG）, C-reactive protein（CRP）, interleukin 6 （IL-6）, tumor necrosis factor α（TNF-α）, glutathione peroxidase（GPX） ,superoxide dismutase（SOD） were measured before and 72 h after PCI. Contrast-induced nephropathy in two groups was analyzed. Results No significant difference was found in the incidence of contrast-induced nephropathy between the two groups after PCI（P〈0.05）. The serum levels of CRP, SOD and GPX were significantly higher in the two groups 72 h after PCI （P〉0.05） than before PCI. However, no significant difference was observed in the serum levels of Scr,CRP,BUN,β2-MG,IL-6,TNF-α,GPX,and SOD between the two group 72 h after PCI（P〉0.05）. Conclusion NAC has no preventive effect on contrast-induced nephropathy in elderly CHD patients after PCI.