N-乙酰半胱氨酸对冠状动脉介入治疗后对比剂肾病的预防作用

The Preventive Effects of N-Acetylcysteine on Contrast-Induced Nephropathy in Patients Undergoing Elective Percutaneous Coronary Intervention

目的探讨N-乙酰半胱氨酸(NAC)对择期经皮冠状动脉介入治疗(PCI)术后发生对比剂肾病(CIN)是否具有预防作用。方法选取行择期PCI术的患者521例,随机分为NAC组和常规治疗组,其中NAC组260例,给予NAC+水化治疗;常规治疗组261例,仅给予水化治疗。观察2组PCI术前及术后72h血肌酐(Scr)、尿素氮(BUN)、肌酐清除率(Ccr)、C-反应蛋白(CRP)、β2微球蛋白(β2-MG)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、过氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GPX)及CIN发病率的变化。结果 (1)NAC组的CIN发病率(6.2%)与常规治疗组(3.8%)差异无统计学意义(χ2=1.48,P>0.05)。(2)2组PCI术前的血Scr、BUN、Ccr、CRP、β2-MG、TNF-α、IL-6、SOD及GPX水平差异无统计学意义(P>0.05)。(3)PCI术后72h,2组CRP、SOD、GPX均较术前升高(P<0.05);NAC组CRP、SOD、GPX水平低于常规治疗组(P<0.05);NAC组Scr、BUN、β2-MG、Ccr水平较常规治疗组无明显变化(P>0.05)。结论 NAC对PCI术后CIN的发生可能无预防作用。

Objective To investigate the preventive effect of N-acetylcysteine （NAC） on contrast-induced nephropa- thy （CIN） in patients undergoing elective percutaneous coronary intervention （PCI）. Methods A total of 521 patients underwent PCI in Tianjin were randomly divided into conventional treatment group （n--261） and NAC treatment group （n=260）. NAC treatment group was given oral NAC （600 mg twice daily） for 48 h and 72 h before PCI plug hydration therapy, and the conventional treatment group was given only hydration therapy. The serum levels of creatinine （Scr）, urea nitrogen （BUN）, creatinine clearance rate （Cer）, C-reactive protein （CRP）, ~2-microglobulin（~2-MG）, tumor necrosis factor-a （TNF-a）, inter- leukin-6 （IL-6）, superoxide dismutase （SOD）, glutathione peroxidase （GPX） and incidence of CIN were detected at admission and 72 h after the procedure. Results （1） There was no significant difference in the incidence of CIN between NAC treatment group （6.2%） and conventional treatment group （3.8%, X2=1.48, P 〉 0.05）. （2） There were no significant differences in serum levels of Scr, BUN, Cer, CRP,x2-MG, TNF-oL, IL-6, SOD and GPX before PCI （ P 〉 0.05）. （3） The serum levels of CRP, SOD and GPX were significantly higher 72 h after the procedure in two groups （ P 〈 0.05）. There were significantly lower se- rum levels in CRP, SOD and GPX in NAC treatment group than those of conventional treatment group （ P 〈0.05）. There were no significant differences in serum levels of Scr, BUN, x2-MG and Ccr between NAC treatment group and conventional treat- ment group （ P 〉 0.05）. Conclusion N-acetylcysteine may have no beneficial effect on the prevention of CIN after PCI.