Meta-analysis Of Reduced Glutathione For Prevention Of Contrast-induced Nephropathy

Background:Contrast-induced nephropathy(CIN)refers to acute renal impairment(excluding other causes)occurring 2 to 3 days after the use of contrast agents,and has become the third cause of acquired acute renal failure in hospitals.At present,the contrast agents commonly used in clinical practice are hypotonic and isotonic.The greater the osmotic pressure of the contrast agent,the greater the toxicity;the greater the dose,the greater the toxicity.The pathogenesis of contrast-induced nephropathy is complex and needs further clarification.Hydration therapy is routinely used clinically to prevent the development of CIN.Reduced glutathione(GSH)is composed of cysteine,glutamic acid and glycine and has a reducing oxidation effect.Recent studies have shown that reduced glutathione has a certain preventive effect on contrast nephropathy,but studies have also reported that reduced glutathione can not reduce the incidence of contrast nephropathy.Objective:To systematically evaluate whether reduced glutathione can effectively prevent contrast nephropathy.Methods:According to the Cochrane system evaluation requirements,the search methods,inclusion and exclusion criteria were established,and the Wanfang database,China Journal Full-text Database(CNKI),Weipu Information and China Biomedical Literature Database(CBM),Pubmed,and Embase databases were searched by computer.The retrieval period was from the establishment of the database to December2018.According to the inclusion and exclusion criteria,the detected documents were reviewed,and the data were extracted,the quality of the included documents was evaluated,and analyzed by Revman 5.3 software.Results:A total of 8147 related documents were retrieved,and only7 articles eligible for screening were selected.Among them,5 Chinese literatures and 2 English literatures,the cumulative total number of cases was 1738,the GSH group(experimental group)898 cases,and the control group 840 cases.The results of the meta-analysis showed that the heterogeneity of the included literature was small(I~2=44%,P=0.10),Reduced glutathione can prevent contrast-induced nephropathy(OR=0.62,95%CI:0.42 to 0.92,P=0.02);and can reduce serum creatinine concentration(MD=-5.62,95%CI:-10.78 to-0.46)and serum cystatin C concentration(MD=-0.22,95%CI:-0.29 to-0.15);however,no effect on glomerular filtration rate(MD=4.57,95%CI:-5.68 to 14.82).Conclusion:1.Reduced glutathione may reduce the incidence of contrast nephropathy.2.Reduced glutathione may reduce the elevated levels of serum creatinine and serum cystatin C after angiography,suggesting that it may have a protective effect on the kidney.