Protective Effects Of Lipoic Acid On Acute Renal Dysfunction Induced By Iohexol After Coronary Angiography

Objective:To investigate the protective effects of lipoic acid on acute renal dysfunction induced by iohexol after coronary angiographyMethods: From January 2017 to July 2017,300 patients with coronary heart disease who underwent coronary angiography in Department of Cardiology,Huaihua Hospital Affiliated to Nanhua University were selected.And they were randomly divided into 150 cases of the saline control group and 150 cases of the lipoic acid group.All of them received routine treatment,such as active control of blood sugar and blood pressure,platelet aggregation and lipid-lowering therapy.All the patients were treated with 0.9% Sodium Chloride Injection(1ml/kg/h)hydration 3 hours before coronary angiography,and maintained until 9h after operation,Except for control patient oral drinking water.In the saline control group,0.9% sodium chloride solution(250ml)were intravenously dripped 24 h and 48 h after the operation.In the lipoic acid group,0.9% sodium chloride(250ml)added to the lipoic acid injection(600mg)was intravenously input 1h before operation,24 h and 48 h after operation at the same time of routine treatment.Serum creatinine(Scr),estimated glomerular filtration rate(e GFR),urinary N-acetyl-beta aminoglucosidase(NAG),serum malondialdehyde(MDA)and serum superoxide dismutase(SOD)were compared between the two groups before and after the operation,and the changes in these parameters before and after the operation and the incidence of contrast agent induced nephropathy were also compared.Results: 1?The effect of contrast agent iodohydride on renal function: in the saline control group,SCr(133.08±61.45)umol/L was higher than pre-operation(108.25±67.97)umol/L(p< 0.01),and e GFR(57.18±7.52)was lower than pre-operation(74.75±3.27)(p < 0.01).The postoperative SCr(112.30±60.57)umol/L of the lipoic acid group increased than preoperative(107.88±61.53)umol/L(p< 0.01),and e GFR(73.23±6.07)decreased(75.89±5.69)after operation(p< 0.01),suggesting that the renal glomerular dysfunction occurred in the two groups after the use of intravenous contrast agents.The comparison of renal tubular function: the urine NAG in both groups increased after operation the urine NAG(26.84±0.75)U/L after operation was higher than that before operation(19.02±0.52)U/L(p< 0.01),and the urine NAG(23.44±0.68)U/L in the group of sulphur octanic acid increased(18.92±0.46)U/L(p< 0.01)before operation(18.92±0.46)U/L(p < 0.01),suggesting that the renal tubule function was damaged after the use of contrast agent in twogroup.2?The protective effect of lipoic acid on the function of glomerulus and renal tubule: the difference of SCr(23.07±29.38)mmol/L before operation was higher than that of lipoic acid group(10.93±30.78)mmol/L(p< 0.05).The difference of e GFR(-14.93±7.92)in conventional hydration group was higher than that of lipoic acid group(-3.32±7.18)(p< 0.05),indicating that the glomerular function is evil in the group of lipoic acid.The degree of chemistry was lighter than that in the simple hydrated group.The difference(4.94±0.47)U/L of the urine NAG before operation in the group of lipoic acid was less than that of the hydrated group(6.79±0.48)U/L(p< 0.01),indicating that the deterioration of renal tubule function in the sulphate octanic acid group was lighter than that in the simple hydrated group.In saline control group,CIN occurred in 11 cases(7.3%),and lipoic acid group occurred CIN in 3 cases(2%)(p < 0.05).3?Two groups of MDA and SOD changes: MDA(6.31±0.85)(nmol·ml-1)in the saline control group was higher than before operation(4.65±0.65)(nmol·ml-1)(p< 0.01),and MDA(5.09±0.55)(nmol·ml-1)in the sulphur octanic acid group increased before operation(4.67±0.99)(nmol·ml-1)(p<0.05),suggesting that patients in the two group were using contrast agents.After all the process of oxygen free radical damage.However,the MDA difference(1.62±0.89)(nmol·ml-1)in the hydrated group was higher than that of the lipoic acid group(0.71±0.34)(nmol·ml-1)(p < 0.01),suggesting thatthe degree of oxygen free radical in the sulphur octanic acid group was less than that in the simple hydrated group.The SOD(88.51±6.93)(U/ml)in the saline control group decreased(98.40±9.30)(U/ml)before operation(p<0.01),indicating the decrease of antioxidant enzyme SOD in the saline control group,which resulted in the decrease of the body's ability to remove oxygen free radicals.The SOD(106.93 ± 10.15)(U/ml)in the thioctanic acid group increased(96.43±8.55)(U/ml)before the operation(p< 0.01),suggesting that the anti oxidant oxidase of thioctanoic acid group was added to the application of the contrast agent on the basis of the use of the contrast agent.The antioxidant enzyme SOD activity was improved and the oxygen free radicals produced in the body were better removed.4?The protective effect of lipoic acid on renal function is related to the changes of MDA and SOD.in the group of lipoic acid,the difference of serum creatinine difference before operation was the same as that of MDA before operation,but opposite to the trend of SOD difference;there was a positive correlation between the difference of serum creatinine difference and the difference of MDA in the group of alpha lipoic acid(r=0.941,p<0.01),and there was a negative correlation with the difference of SOD(r=-0.877,p<0.01).Part of the damage to the kidney is due to the effect of free radicals,and lipoic acid plays a role in protecting the function of the kidney by improving the SOD activity of the body and removing the oxygen free radicals.Conclusion:1.Iohexol can cause acute renal injury;2.Lipoic acid intervention can reduce the occurrence of renal injury in patients with coronary angiography.The mechanism may be related to the anti-oxidation effect of lipoic acid.