维生素C预防老年肾功能不全患者造影剂性肾病的临床疗效

Ascorbic acid in prevention of contrast-induced nephropathy in elderly patients with renal insufficiency

摘要:

目的探讨对拟行冠状动脉造影的老年基础肾功能不全患者应用维生素C预防造影剂性肾病的安全性和临床疗效。方法本研究为单中心前瞻性随机对照临床试验,连续入选132例血清肌酐≥11mg/L(97.2μmol/L)拟行冠状动脉造影的老年患者,随机分为两组。干预组(n=70)在水化基础上于造影前经静脉予维生素C3g及造影后口服维生素C0.5g2次/d,连服2d;对照组(n=62)仅生理盐水水化;所有患者均于术前及术后接受常规水化,观察术后患者的肾功能及心血管事件。结果维生素C干预组与对照组,在主要终点指标即术后48h内血清肌酐峰值变化上,两组之间无显著性差异(0.2±1.7)vs(0.3±2.2)mg/L,P=0.625;在次要终点即造影剂性肾病的发病率上,维生素C干预组较对照组低,但无显著性差异(5.6%vs8.1%,P=0.594)。两组患者在院内临床预后及住院时间上无明显差异。结论对于行冠脉造影的老年基础肾功能不全患者短程应用大剂量维生素C有降低造影剂性肾病发生的趋势。

Abstract:

Objective To evaluate the safety and efficacy of ascorbic acid in reducing the risk of contrast-induced nephropathy in the elderly renal insufficiency patients who were scheduled to undergo coronary angiography.Methods We conducted a single-center,prospective,randomized,controlled trial.A total of 132 consecutive elderly patients with stable serum creatinine levels of at least 11 mg/L(≥97.2 μmol/L),scheduled to undergo coronary angiography,were randomized into ascorbic acid (n=70) and control groups (n=62).In ascorbic acid group,patients received intravenous hydration of ascorbic acid (3 g) before the procedure and oral hydration of ascorbic acid after the procedure (0.5 g once,1 g/d,2 days).In control group,sodium chloride alone was given.The patients’ renal function and cardiovascular events after the procedure were compared between the two groups.Results There was no difference between ascorbic acid group and control group in primary end point,the mean peak increase in serum creatinine measured within 48 hours after coronary angiography (0.2±1.7) vs (0.3±2.2)mg/L,P= 0.625.The incidence of contrast-induced nephropathy,a secondary end point,was 5.6% (4/70) in ascorbic acid group and 8.1% (5/62) in control group,with no significant difference between the two groups (P=0.594).There was either no difference between the two groups in the in-hospital clinical outcomes or length of hospital stay.Conclusion For the elderly patients with renal insufficiency who were scheduled to undergo coronary angiography,short-term application of high-dose ascorbic acid could reduce the incidence of contrast-induced nephropathy.?更多