N-乙酰半胱胺酸对高龄患者对比剂肾病的预防作用

目的 探讨N-乙酰半胱氨酸（N-acetylcysteine,NAC）对行增强CT检查的高龄患者对比剂肾病（contrast-induced nephropathy,CIN）的预防作用.方法 将行增强CT检查的高龄患者56例,采用随机数字表法随机分为NAC组28例、对照组28例.NAC组于增强CT检查前12 h、6 h,检查后6 h、12 h分别口服NAC泡腾片1 200 mg,2组均给予水化治疗,比较CT前后2组患者血肌酐和估算肾小球滤过率（estimated glomerular filtration rate,eGFR）变化,以及2组患者CIN发生率.结果 NAC组与对照组比较,增强CT检查后48 h,2组患者SCr水平均高于CT检查前（P＜0.01）,eGFR水平均低于CT检查前（P＜0.01）;检查前后NAC组SCr升高幅度与对照组比较差异无统计学意义（P＞0.05）,检查前、后NAC组eGFR下降幅度小于对照组,差异有统计学意义（P＜0.05）.NAC组无CIN发生,对照组仅有1例在行CT检查后SCr明显升高（SCr升高19.4 μmol/L,上升幅度28%）,但无临床意义,2组经校正的四格表χ2检验,差异无统计学意义（P＞0.05）.结论 NAC联合水化治疗对患者行增强CT所致CIN的预防作用与单纯水化治疗相当.说明大剂量NAC对对比剂引起的肾损害具有一定的防治作用.

Preventive effect of N-acetylcysteine on contrast-induced nephropathy in elderly patients

Objective To explore the preventive effect of N-acetylcysteine （NAC） on contrastinduced nephropathyt Cllv） in elderly patients undergoing contrast-enhanced CT. Methods A total of 56 patients older than 75 years undergoing contrast-enhanced CT procedures were enrolled in this study. All patients were randomly divided into NAC group （n = 28） and control group （n = 28）. In NAC group,NACO 200 mg） was administrated orally, 12 and 6 h before and 6 hand 12 h after the contrastenhanced CT scan. All patients received 0. 9 % saline infusion 12 h before and 12 h after the contrastenhanced CT scan. Serum creatininet （SCr） levels were assessed at baseline and 48 h after the contrastenhanced CT scan and the incidence of CIN was analyzed. Results No CIN occurred in NAC group and there was one patient who was diagnosed as having CIN in control group（P〉0. 05）. The levels of SCr after the contrast-enhanced CT scan had a decreasing tendency in NAC group in comparison to those in control groupe P〉0. 05）. The level of estimated glomerular filtration rate （eGFR） after the contrastenhanced CT scan was higher in NAC group than that in control group （P〈0.05）. Conclusious NAC in combination with saline infusion did not show additional protective effects on renal function of the elderly patients undergoing iohexol-enhanced CT procedures as compared to saline used alone.