NEJM:碳酸氢钠和乙酰半胱氨酸皆不能降低造影剂相关肾损伤

2018-03-05 杨中华 脑血管病及重症文献导读

造影剂相关急性肾损伤可以引起死亡,促进慢性肾病的进展,需要透析治疗,增加花费。为了预防这个并发症,通常于围手术期静脉给予等渗氯化钠输注。


造影剂相关急性肾损伤可以引起死亡,促进慢性肾病的进展,需要透析治疗,增加花费。为了预防这个并发症,通常于围手术期静脉给予等渗氯化钠输注。

有人认为碱化尿液以及清除活性氧能够缓解碘造影剂造成的肾小管上皮细胞损伤。正是基于这个假说,一些研究比较了静脉输注碳酸氢钠与静脉输注氯化钠的疗效,也评价了乙酰半胱氨酸预防造影剂相关急性损伤的疗效,但是取得了矛盾的结果。

2018年2月来自比兹堡的S.D. Weisbord等在NEJM上公布了PRESERVE试验结果,目的在于比较静脉输注碳酸氢钠和静脉输注氯化钠,以及比较口服乙酰半胱氨酸和口服安慰剂对进行血管造影高风险患者的严重不良结局和急性肾损伤的疗效。

该研究为双盲,安慰剂对照,comparator-drug–controlled,随机2*2析因设计的试验。纳入的患者为计划进行冠脉或非冠脉血管造影者,并且估计肾小球滤过率(eGFR)介于15 - 44.9/min/1.73m2体表面积者,或eGFR介于45 - 59.9/min/1.73m2合并糖尿病者。纳入的患者随机静脉给予1.26%碳酸氢钠或0.9%氯化钠,以及为期5天口服乙酰半胱氨酸或安慰剂。4993例患者包括在改良ITT分析中。主要复合终点为90天死亡,需要透析,或血肌酐持续升高超过50%。二级终点为造影剂相关急性肾损伤。

经过预先设定的间断分析后,发起者终止了该试验。就主要终点而言,碳酸氢钠和乙酰半胱氨酸之间不存在交互作用(P = 0.33)。碳酸氢钠组和氯化钠组主要终点发生率分别为4.4%和4.7%((OR, 0.93; 95% CI, 0.72 to 1.22; P = 0.62),乙酰半胱氨酸组和安慰剂组分别为4.6%和4.5%(OR, 1.02; 95% CI, 0.78 to 1.33; P = 0.88)。组间也未发现造影剂相关肾损伤发生率的差异。

最终作者认为对于需要造影的肾脏并发症高风险者,静脉输注碳酸氢钠(vs氯化钠)或口服乙酰半胱氨酸(vs安慰剂)皆不能预防90天死亡、需要透析和肾功能持续下降者的比例。

原始出处:

Steven D. Weisbord,,et al.Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine.N Engl J Med. 2018 Feb 15;378(7):603-614. doi: 10.1056/NEJMoa1710933. Epub 2017 Nov 12.

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    2019-07-18 litao810414

    好文章,实践出真知

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    2018-03-07 sodoo
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    2018-03-06 owlhealth

    学习了.不错耶

    0

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    2018-03-05 1e160a78m83(暂无匿称)

    学习啦.以前都不知道碳酸氢钠能治疗肾损伤

    0

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    2018-03-05 happsf

    学习

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