N-乙酰半胱氨酸对老年糖尿病患者造影剂肾病的预防作用

目的观察N-乙酰半胱氨酸(N-acetylcysteine,NAC)对肾功能正常或轻度肾功能不全的老年糖尿病患者造影剂肾病的预防作用。方法拟采用低渗造影剂进行增强CT检查70例年龄>60岁、糖尿病史1a以上的正常或轻度肾功能不全患者,随机分为NAC组与对照组各35例,NAC组造影前1d及造影后连续2d口服NAC,600mg/次;2组均给予水化治疗;比较造影前和造影后24,48h2组血肌酐、尿素氮和血胱抑素C水平及造影剂肾病发生率。结果 NAC组无造影剂肾病发生,对照组发生造影剂肾病2例,2组比较差异无统计学意义(P>0.05);增强CT检查后48h,NAC组血肌酐、尿素氮和血胱抑素C水平低于对照组,估测肾小球滤过率水平高于对照组(P<0.05)。结论 NAC联合水化治疗对肾功能接近正常的老年糖尿病患者造影剂肾病有一定预防作用。

Effect of N-acetylcysteine on preventing contrast-induced nephropathy in elderly diabetic patients

Objective To study the effect of N-acetylcysteine(NAC) in preventing contrast-induced nephropathy(CIN) after iohexol-enhanced CT procedures in elderly diabetic patients with normal renal function or mild renal insufficiency.Methods A total of 70 diabetic patients older than 60 years with normal renal function or mild renal insufficiency undergoing contrast-enhanced CT procedures were randomly divided into NAC group and control group,with 35 cases in each group.NAC group was given NAC 600 mg orally,twice daily,before and after examination) plus saline hydration,and control group was given only saline hydration.The levels of blood urea nitrogen(BUN),serum creatinine(SCr),cystatin C(Cys C) and estimated glomerular filtration rate(eGFR) were measured before examination,and 24 and 48 hours after examination.Results No CIN occurred in NAC group and 2 cases of CIN occured in control group,which showed no significant difference between two groups(P>0.05).The levels of SCr,BUN and Cys C were significantly lower 48 hours after examination in NAC group than those in control group(P<0.05).The level of eGFR was higher in NAC group than that in control group(P<0.05).Conclusion NAC combined with saline hydration can protect the renal function in the elderly diabetic patients with normal renal function undergoing iohexol-enhanced CT procedures.