N-乙酰半胱氨酸对冠状动脉介入治疗相关对比剂诱导的急性肾损伤预防作用
发布时间：2018-10-10 14:09
【摘要】：目的： 探讨N-乙酰半胱氨酸(N-acetylcysteine, NAC)对冠状动脉介入治疗(percutaneous coronary intervention, PCI)相关对比剂诱导急性肾损伤(contrast induced acute kidney injury, CIAKI)是否具有预防作用及作用机理。 方法： 前瞻性入选2011年5月至2013年6月于天津市胸科医院心内科行择期PCI患者共521例,按照随机数字表法将其分为两组：NAC组和常规治疗组,其中,NAC组260例,男性192例,女性68例,平均年龄(61.38±10.72)岁；常规治疗组261例,男性192例,女性69例,平均年龄(62.79±10.41)岁。两组患者均于PCI术前及术后6-12h给予等渗氯化钠盐水以1mL·kg+1·h-1速度进行水化,心功能不全或左心射血分数45%的患者,则以0.5mL·kg-1·h-1速度进行水化。此外,NAC组患者分别于PCI术前2d和术后3d给予口服NAC(武汉远大弘元药业有限公司生产)600mg Bid。收集两组患者的临床资料、对比剂用量,观察两组患者PCI术前及术后72h血尿素氮(BUN)、血清肌酐(Scr)、肌酐清除率(Ccr)、β2微球蛋白(p2-MG)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、过氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GPX)的变化,记录两组患者CIAKI发生情况。CIAKI定义为：除外其它影响肾损伤的因素,应用对比剂后72h内,Scr水平较原有基础升高25%或绝对值升高0.5mg/dL(44.2μmol/L)以上Ccr按Cockcraft-Gault公式计算,Ccr=(140-年龄)×体质量(kg)×0.85(女性)/72×Scr。 结果： (1)两组患者PCI术前基本临床情况差异未见统计学意义(P0.05) (2)PCI术前,NAC组与常规治疗组血Scr、BUN、Ccr、CRP、p2-MG、TNF-α、 IL-6、SOD、GPX水平,差异未见统计学意义(P0.05)。 (3)PCI术后72h,NAC组与常规治疗组患者Scr、BUN、Ccr、β2-MG、TNF-αIL-6水平均较术前无明显变化,差异未见统计学意义(P0.05)。 (4)PCI术后72h,无论NAC组还是常规治疗组CRP、SOD、GPX水平均较术前增高,差异可见统计学意义(P0.05)。 (5)PCI术后72h, NAC组CRP、SOD、GPX水平低于常规治疗组,差异可见统计学意义(P0.05)。 (6)NAC组260例患者中有16例发生CIAKI, CIAKI发病率为6.2%；常规治疗组261例患者中有10例发生CIAKI, CIAKI发病率为3.8%,差异未见统计学意义(χ2=1.48,P0.05)。总共26例CIAKI患者,血Scr在第5d出院时均恢复至PCI术前基线水平。 结论： (1)炎症反应及氧化应激在CIAKI的发病机制中可能起到一定的作用。 (2)NAC尽管能有效降低氧化及炎症因子水平,但尚不足以预防PCI相关CIAKI的发生。
[Abstract]:Aim: to investigate the preventive effect and mechanism of N-acetylcysteine (NAC) on acute renal injury induced by (percutaneous coronary intervention, PCI) in coronary artery intervention. Methods: from May 2011 to June 2013, 521 patients with elective PCI were enrolled in cardiology department, Tianjin chest Hospital. They were randomly divided into two groups: NAC group and routine treatment group, including 260 cases in NAC group. There were 192 males and 68 females with an average age of (61.38 卤10.72) years, 261 patients in the routine therapy group, 192 males and 69 females, with an average age of (62.79 卤10.41) years. The patients in both groups were hydrated with 1mL kg 1 h-1 velocity before and 6 to 12 hours after PCI, while those with cardiac insufficiency or left ventricular ejection fraction (45%) were hydrated at 0.5mL kg-1 h -1 velocity. In addition, patients in NAC group were given oral NAC (Wuhan Broad Hongyuan Pharmaceutical Co., Ltd.) 600mg Bid. 2 days before and 3 days after PCI. Collect the clinical data of the two groups of patients, contrast the dosage of the drug, The serum creatinine (Scr), creatinine clearance rate (p2-MG), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor- 伪 (TNF- 伪) and (SOD), glutathione peroxidase (GPX) (SOD), Glutathione peroxidase (GPX) were measured before and 72 hours after PCI. The incidence of CIAKI was recorded in two groups. CIAKI was defined as: excluding other factors affecting renal injury, the level of Scr increased by 25% or the absolute value of Ccr (44.2 渭 mol/L) more than 0.5mg/dL (44.2 渭 mol/L) by 25% within 72 hours after application of contrast agent, Ccr= (140-age) 脳 (kg) 脳 0.85 (F) / 72 脳 Scr. was calculated according to Cockcraft-Gault formula, Ccr= (140-age) 脳 (kg) 脳 0.85 (female) / 72 脳 Scr.. Results: (1) there was no significant difference in the basic clinical status of PCI between the two groups (P0.05). (2) before PCI, the levels of Scr,BUN,Ccr,CRP,p2-MG,TNF- 伪 and IL-6,SOD,GPX in the NAC group and the routine treatment group were higher than those in the control group. There was no significant difference in Scr,BUN,Ccr, 尾 2-MGG TNF- 伪 IL-6 between the PCI group and the routine treatment group at 72 h after PCI (P0.05), and there was no significant change in the level of Scr,BUN,Ccr, 尾 2-MGG TNF- 伪 IL-6 between the two groups. There was no significant difference (P0.05). (4) at 72 hours after PCI. The level of CRP,SOD,GPX in both NAC group and routine treatment group was higher than that in preoperative group. The difference was statistically significant (P0.05). (5) at 72 hours after PCI. The CRP,SOD,GPX level of NAC group was lower than that of routine treatment group. The difference was statistically significant (P0.05). (6) the incidence rate of CIAKI, CIAKI was 6.2 in NAC group and 3.8in routine treatment group (蠂 21.48 P 0.05). In a total of 26 patients with CIAKI, blood Scr recovered to baseline level before PCI on day 5. Conclusion: (1) inflammatory response and oxidative stress may play a role in the pathogenesis of CIAKI. (2) although NAC can effectively reduce the levels of oxidation and inflammatory factors, it is not sufficient to prevent the occurrence of PCI related CIAKI.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692;R541.4
本文编号：2262083
[Abstract]:Aim: to investigate the preventive effect and mechanism of N-acetylcysteine (NAC) on acute renal injury induced by (percutaneous coronary intervention, PCI) in coronary artery intervention. Methods: from May 2011 to June 2013, 521 patients with elective PCI were enrolled in cardiology department, Tianjin chest Hospital. They were randomly divided into two groups: NAC group and routine treatment group, including 260 cases in NAC group. There were 192 males and 68 females with an average age of (61.38 卤10.72) years, 261 patients in the routine therapy group, 192 males and 69 females, with an average age of (62.79 卤10.41) years. The patients in both groups were hydrated with 1mL kg 1 h-1 velocity before and 6 to 12 hours after PCI, while those with cardiac insufficiency or left ventricular ejection fraction (45%) were hydrated at 0.5mL kg-1 h -1 velocity. In addition, patients in NAC group were given oral NAC (Wuhan Broad Hongyuan Pharmaceutical Co., Ltd.) 600mg Bid. 2 days before and 3 days after PCI. Collect the clinical data of the two groups of patients, contrast the dosage of the drug, The serum creatinine (Scr), creatinine clearance rate (p2-MG), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor- 伪 (TNF- 伪) and (SOD), glutathione peroxidase (GPX) (SOD), Glutathione peroxidase (GPX) were measured before and 72 hours after PCI. The incidence of CIAKI was recorded in two groups. CIAKI was defined as: excluding other factors affecting renal injury, the level of Scr increased by 25% or the absolute value of Ccr (44.2 渭 mol/L) more than 0.5mg/dL (44.2 渭 mol/L) by 25% within 72 hours after application of contrast agent, Ccr= (140-age) 脳 (kg) 脳 0.85 (F) / 72 脳 Scr. was calculated according to Cockcraft-Gault formula, Ccr= (140-age) 脳 (kg) 脳 0.85 (female) / 72 脳 Scr.. Results: (1) there was no significant difference in the basic clinical status of PCI between the two groups (P0.05). (2) before PCI, the levels of Scr,BUN,Ccr,CRP,p2-MG,TNF- 伪 and IL-6,SOD,GPX in the NAC group and the routine treatment group were higher than those in the control group. There was no significant difference in Scr,BUN,Ccr, 尾 2-MGG TNF- 伪 IL-6 between the PCI group and the routine treatment group at 72 h after PCI (P0.05), and there was no significant change in the level of Scr,BUN,Ccr, 尾 2-MGG TNF- 伪 IL-6 between the two groups. There was no significant difference (P0.05). (4) at 72 hours after PCI. The level of CRP,SOD,GPX in both NAC group and routine treatment group was higher than that in preoperative group. The difference was statistically significant (P0.05). (5) at 72 hours after PCI. The CRP,SOD,GPX level of NAC group was lower than that of routine treatment group. The difference was statistically significant (P0.05). (6) the incidence rate of CIAKI, CIAKI was 6.2 in NAC group and 3.8in routine treatment group (蠂 21.48 P 0.05). In a total of 26 patients with CIAKI, blood Scr recovered to baseline level before PCI on day 5. Conclusion: (1) inflammatory response and oxidative stress may play a role in the pathogenesis of CIAKI. (2) although NAC can effectively reduce the levels of oxidation and inflammatory factors, it is not sufficient to prevent the occurrence of PCI related CIAKI.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692;R541.4
【引证文献】
相关期刊论文 前1条
1 严俊;史婷婷;庄让笑;蔡兆斌;;N-乙酰半胱氨酸对心脏等重要脏器作用的研究进展[J];中国医药导报;2016年12期
，本文编号：2262083
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