Effect Of N-acetylcysteine In Prevention Of Concrast-induced Nephropathy In Patients Undergone Coronary Angiography: A Meta-analysis

Purpose:In recent years,the people of coronary heart disease is increasing,and the fast development of Interventional radiological procedures and contrast agents are widely used in interventional radiography procedures,the application of contrast agents in interventional radiotherapy has become more and more extensive,especially cardiovascular imaging and percutaneous interventions.The increasing incidence of contrast-induced nephropathy(CIN)which is the third major reason of hospital-acquired acute renal insufficiency,especially for those patients with chronic kidney disease,which not only prolongs the hospitalization time and wastes of medical resources,but also leads to grave expact on prognosis of the patients.N-acetylcysteine(NAC)is a commonly used antioxidant that plays a role in the treatment of various diseases such as heart and kidney diseases.However,numerous trials and meta-analyses had been reported,it still unclear whether NAC can be used to prevent CIN in patients undergoing coronary angiography as an effective agent.The aim of this study was to explore the effect of NAC in prevention of CIN in patients with chronic renal insufficiency undergone coronary angiography(CAG).Methods:Randomized controlled trials(RCTs)published prior to September2018 that evaluated the effect of NAC for the prevention of CIN in patients undergone CAG were retrieved from the databases of CNKI,VIP,and WanFang,MEDLINE,Embase,Cochrane library,and pubmed.Two researchers assessed the quality of included studies and extracted data and evaluated the bias risk independently.Review Manager 5.3 software was used for statistical analysis.Results:Twenty-five RCTs enrolling 3021 patients were included in this analysis(1483 patients were assigned to the NAC group and 1538 patients were assigned to the control group).Our result show that NAC significantly reduce the incidence of CIN[relative risk(RR)=0.67,95%CI(0.56 to 0.80),P<0.05].There was evidence of non-significant heterogeneity in NAC effect across studies(I~2=39%).The levels of SCr[Mean difference(MD)=-0.07,95%CI(-0.20 to 0.07),P=0.05],BUN[SMD=-0.16,95%CI(-0.31 to-0.01),P<0.05]and BUN[MD=-1.51,95%CI(-4.00,0.97),P=0.23]were non-significantly lower than in placebo group after CAG/PCI.Conclusion:Our analysis suggested that the NAC can reduce the risk of CIN in patients with chronic renal insufficiency after cardiac catheterization,however,the short-term protective effect of renal function remains to be evaluated.