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*

摘要

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72 h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72 h，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 under-went 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 (Ccr), C-reactive protein (CRP),β2-microglobulin(β2-MG), tumor necrosis factor-α(TNF-α), 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 treat-ment group (6.2%) and conventional treatment group (3.8%,χ2=1.48, P>0.05). (2) There were no significant differences in se-rum levels of Scr, BUN, Ccr, CRP,β2-MG, TNF-α, 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,β2-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.