摘要
目的比较口服与静脉注射途径给药对N-乙酰半胱氨酸（N-acetylcysteine，NAC）预防轻度肾功能异常患者接受增强电子计算机断层扫描成像（computed tomography，CT）后对比剂肾病（contrast-induced nephropathy，CIN）的疗效。方法选择2013年7月至2015年1月武汉大学中南医院接受增强CT检查且肾功能轻度受损的97例患者，按照随机数字表法将患者分为口服NAC组（48例）及静脉注射NAC组（49例）；其中口服NAC组患者于增强CT检查前1d开始口服NAC泡腾片（600mg／片）1200mg，2次／d，共2d，并于CT检查前1h静脉注射10％葡萄糖注射液250ml；静脉注射NAC组患者增强CT检查前1h及检查后第2天各静脉注射NAC4g＋10％葡萄糖注射液250ml。2组患者均于CT检查后均立即静脉注射0．9％氯化钠注射液500ml，并自由饮水。观察2组患者使用对比剂（碘帕醇）前与使用后48h血肌酐（SCr）、血清胱抑素C（Cystatin C，CysC）及估算肾小球滤过率（estimated glomerular filtration rate，eGFR）的变化，并统计2组患者CIN发生率。结果口服NAC组患者SCr及CysC水平较增强CT检查前升高（P〈0．05），eGFR水平较CT检查前降低（P〈0．05）；静脉注射NAC组患者增强CT检查前后SCr、CysC及eGFR水平差异无统计学意义（P〉0．05）；口服NAC组患者增强CT检查后SCr及CysC水平较静脉注射NAC组升高（P〈0．05），eGFR水平较静脉注射NAC组降低（P〈0．05）；口服NAC组有8例患者接受增强CT检查后48h的SCr明显升高。静脉注射NAC组有1例CIN发生，经校正的四格表x2检验，差异有统计学意义（x2=4．547，P=0．033）。结论静脉注射NAC预防CIN的效果较口服给药效果好，临床上对于轻度肾功能不全的患者增强CT检查前、后应静脉途径给予NAC治疗以预防CIN的发生。
Objective To explore the preventive effect of oral and intravenous administration of N-acetylcysteine （NAC） on contrast-induced nephropathy（CIN） in patients with mild renal impairment undergoing contrast-enhanced CT. Methods A total of 97 patients with mild renal impairment undergoing contrast-enhanced CT procedures were enrolled in this study. According to the random number table, all patients were divided into oral NAC group （n = 48） and intravenous group （n = 49）. In oral NAC group, 24 h before and after the contrast-enhanced CT scan, 1 200 mg NAC was administrated orally twice a day, and 10% glucose （250 mL） was injected intravenously 1 h before the CT scan. In intravenous NAC group, 4 g NAC dissolved in 10~/00 glucose （250 mL） was given by intravenous injection 1 h before the CT scan and re-injected on the second day. All patients received 0. 9% saline （500 ml） immediate after the contrast-enhanced CT scan. Serum creatinine （SCr）, Cystatin C （Cys C） and estimated glomerular filtration rate （eGFR） levels were assessed at baseline and 48 h after the contrast-enhanced CT scan, and the incidence of CIN was analyzed. Results The levels of SCr and Cys C after the contrast-enhanced CT scan had an increasing tendency in oral NAC group （P〈 0. 05）, and eGFR had a decreasing tendency after the contrast-enhanced CT scan （P〈0. 05）. There was no significant in levels of SCr, Cys C and eGFR before and her the contrast-enhanced CT scan in intravenous NAC group （P〉0. 05）. The levels of SCr and Cys C after the contrast-enhanced CT scan had an increasing tendency in oral NAC group compared with intravenous NAC group, and eGFR had a decreasing dendency. CIN occurred in one patient of intravenous NAC group, and 8 in oral NAC group （x2 = 4. 547, P = 0. 033）： Conclusions The effect of intravenous NAC administration was better than oral administration in preventing CIN. For the patients with mild renal insufficiency, intravenous NAC should be given before and after the contrast-enhanced CT to prevent CIN.
出处
《临床肾脏病杂志》
2015年第10期604-607,共4页
Journal Of Clinical Nephrology
