还原型谷胱甘肽预防高龄患者冠状动脉造影术后对比剂肾病的随机对照研究

The preventive effect of reduced glutathione on contrast-induced nephropathy in elderly patients undergoing coronary angiography:a randomized,controlled study

目的:采用前瞻性随机对照临床试验评价还原型谷胱甘肽在预防高龄患者冠状动脉造影术后对比剂肾病(contrast-induced nephropathy,CIN)中的作用。方法:连续入选505例行冠状动脉造影术的年龄≥75岁患者,治疗组(n=262)接受还原型谷胱甘肽联合水化治疗;对照组(n=243)仅接受水化治疗。术前和术后48 h测定血清肌酐水平,术后48 h血清肌酐水平较基线值升高≥25%或44.2μmol/L诊断为CIN。结果:术后治疗组CIN的发生率为6.49%,对照组为7.41%,两组无统计学差异(P=0.68);按是否行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)行亚组分析,治疗组和对照组CIN的发生率无统计学差异。结论:应用还原型谷胱甘肽预防高龄患者冠状动脉造影术后CIN并未进一步降低其发生风险。

Objective： To determine whether hydration with reduced glutathione is superior to hydration for the prevention of contrast-induced nephropathy （CIN） in elderly patients undergoing coronary angiography in our prospective randomized controlled clinical study. Methods： 505 patients aged ≥75 years were randomly divided into treatment group receiving hydration with reduced glutathione （n= 262） and control group with hydration （n = 243）. Serum creatinine was measured prior to the procedure and 48 h after coronary angiography. The primary endpoint was occurrence of CIN defined as 25 % above baseline or 44. 2μmol/L in serum creatinine 48 h after the procedure. Results： The overall incidence of CIN was 6. 49 % in treatment group versus 7. 41 % in control group （P = 0. 68）. In the subgroup analysis by percutaneous coronary intervention （PCI）, no statistically significant differences were found between the two groups. Conclusion： Reduced glutathione added to optimal hydration does not seem to further reduce the risk of CIN in elderly patients undergoing coronary angiography.