The Preventive Effects Of N-Acetylcysteine On Contrast Induced Acute Kidney Injury In Patients Undergoing Percutaneous Coronary Intervention

Objective:To explore the effectiveness of N-acetylcysteine (NAC) on the prevention of contrast induced acute kidney injury(CIAKI) in patients treated by percutaneous coronary intervention(PCI).Methods:From May2011to June2013in Cardiology of Tianjin Chest Hospital, prospective selected the521patients treated by PCI. According to random number table, The patients are randomly divided into either NAC group (n=260) or observation group (n=261). The numbers of male in NAC group were192and the female were68. The average age was61.38±10.72years old. The numbers of male in observation group were192and the female were69. The average age was62.79±10.41years old. Both groups received intravenous hydration (saline,1mL kg-1· h-1or0.5mL· kg-1· h-1in the patients with heart failure) within12h before and after the procedure. NAC (WuHan University HoYo Co, LTD)were given the NAC group600mg within12h in2days before and3days after PCI. The levels of blood urea nitrogen(BUN), serum creatinine (Scr), creatinine clearance rate (Ccr), estimated glomerular filtration rate (eGFR), interleukin-6(IL-6),(32-microglobulin (β2-MG), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), Superoxide dismutase (SOD) and glutathione peroxidase (GPX) were measured before and72h after the procedure.Definition of CIAKI:Contrast medium nephrotoxicity is a condition in which an impairment in renal function (an increase in serum creatinine by more than25%or0.5mg/dL (44μmol/L) occurs within72hours after the intravascular administration of a contrast medium in the absence of an alternative cause. CCr (ml/min)=(M)(140-age)×weight (kg)/72×serum creatinine (mg/dL), femal×0.85.Result:(1)It has no statistically significant in both of groups(P>0.05).(2)The levels of Scr, BUN, Ccr, CRP,(32-MG, TNF-α, IL-6, SOD, GPX have no statistically significant in both of groups before PCI(P>0.05). (3)The levels of Scr, BUN, Ccr, CRP, β2-MG, TNF-α, IL-6, SOD,GPX were similar in both of groups after PCI72h(P>0.05).(4)The level of CRP, SOD, GPX72h after PCI were higher than the level before PCI (P<0.05)(5)The level of CRP, SOD, GPX in the group of NAC72h after PCI were lower than the group of observation (P<0.05).(6) The incidence of CIAKI:16patients of NAC group with CIAKI, the rate of the incidence of CIAKI was6.2%,10patients of observation group with CIAKI, the rate of the incidence of CIAKI was3.8%, both of groups have no statistically significant(x2=1.48, P>0.05).26patients with CIAKI in total, the level of Scr was dropped off the baseline levels before PCI.Conclusion:(1)The inflammation and oxidative stress might play a role in the pathogenesis of CIAKI.(2)NAC could reduce the oxidation factor levels effectively, but could not prevent the occurrence of CIAKI after PCI effectively.