N-乙酰半胱氨酸對冠狀動脈介入治療相關(guān)對比劑誘導(dǎo)的急性腎損傷預(yù)防作用
發(fā)布時(shí)間：2018-10-10 14:09
【摘要】：目的： 探討N-乙酰半胱氨酸(N-acetylcysteine, NAC)對冠狀動脈介入治療(percutaneous coronary intervention, PCI)相關(guān)對比劑誘導(dǎo)急性腎損傷(contrast induced acute kidney injury, CIAKI)是否具有預(yù)防作用及作用機(jī)理。 方法： 前瞻性入選2011年5月至2013年6月于天津市胸科醫(yī)院心內(nèi)科行擇期PCI患者共521例,按照隨機(jī)數(shù)字表法將其分為兩組：NAC組和常規(guī)治療組,其中,NAC組260例,男性192例,女性68例,平均年齡(61.38±10.72)歲；常規(guī)治療組261例,男性192例,女性69例,平均年齡(62.79±10.41)歲。兩組患者均于PCI術(shù)前及術(shù)后6-12h給予等滲氯化鈉鹽水以1mL·kg+1·h-1速度進(jìn)行水化,心功能不全或左心射血分?jǐn)?shù)45%的患者,則以0.5mL·kg-1·h-1速度進(jìn)行水化。此外,NAC組患者分別于PCI術(shù)前2d和術(shù)后3d給予口服NAC(武漢遠(yuǎn)大弘元藥業(yè)有限公司生產(chǎn))600mg Bid。收集兩組患者的臨床資料、對比劑用量,觀察兩組患者PCI術(shù)前及術(shù)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-反應(yīng)蛋白(CRP)、白細(xì)胞介素-6(IL-6)、腫瘤壞死因子-α(TNF-α)、過氧化物歧化酶(SOD)、谷胱甘肽過氧化物酶(GPX)的變化,記錄兩組患者CIAKI發(fā)生情況。CIAKI定義為：除外其它影響腎損傷的因素,應(yīng)用對比劑后72h內(nèi),Scr水平較原有基礎(chǔ)升高25%或絕對值升高0.5mg/dL(44.2μmol/L)以上Ccr按Cockcraft-Gault公式計(jì)算,Ccr=(140-年齡)×體質(zhì)量(kg)×0.85(女性)/72×Scr。 結(jié)果： (1)兩組患者PCI術(shù)前基本臨床情況差異未見統(tǒng)計(jì)學(xué)意義(P0.05) (2)PCI術(shù)前,NAC組與常規(guī)治療組血Scr、BUN、Ccr、CRP、p2-MG、TNF-α、 IL-6、SOD、GPX水平,差異未見統(tǒng)計(jì)學(xué)意義(P0.05)。 (3)PCI術(shù)后72h,NAC組與常規(guī)治療組患者Scr、BUN、Ccr、β2-MG、TNF-αIL-6水平均較術(shù)前無明顯變化,差異未見統(tǒng)計(jì)學(xué)意義(P0.05)。 (4)PCI術(shù)后72h,無論NAC組還是常規(guī)治療組CRP、SOD、GPX水平均較術(shù)前增高,差異可見統(tǒng)計(jì)學(xué)意義(P0.05)。 (5)PCI術(shù)后72h, NAC組CRP、SOD、GPX水平低于常規(guī)治療組,差異可見統(tǒng)計(jì)學(xué)意義(P0.05)。 (6)NAC組260例患者中有16例發(fā)生CIAKI, CIAKI發(fā)病率為6.2%；常規(guī)治療組261例患者中有10例發(fā)生CIAKI, CIAKI發(fā)病率為3.8%,差異未見統(tǒng)計(jì)學(xué)意義(χ2=1.48,P0.05)。總共26例CIAKI患者,血Scr在第5d出院時(shí)均恢復(fù)至PCI術(shù)前基線水平。 結(jié)論： (1)炎癥反應(yīng)及氧化應(yīng)激在CIAKI的發(fā)病機(jī)制中可能起到一定的作用。 (2)NAC盡管能有效降低氧化及炎癥因子水平,但尚不足以預(yù)防PCI相關(guān)CIAKI的發(fā)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 鹵10.72) years, 261 patients in the routine therapy group, 192 males and 69 females, with an average age of (62.79 鹵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- 偽 (TNF- 偽) 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- 偽 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- 偽 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- 偽 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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692;R541.4
本文編號：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 鹵10.72) years, 261 patients in the routine therapy group, 192 males and 69 females, with an average age of (62.79 鹵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- 偽 (TNF- 偽) 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- 偽 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- 偽 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- 偽 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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692;R541.4
【引證文獻(xiàn)】
相關(guān)期刊論文 前1條
1 嚴(yán)俊;史婷婷;莊讓笑;蔡兆斌;;N-乙酰半胱氨酸對心臟等重要臟器作用的研究進(jìn)展[J];中國醫(yī)藥導(dǎo)報(bào);2016年12期
，本文編號：2262083
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