静脉应用n-乙酰半胱氨酸预防造影剂肾病的随机对照试验meta分析

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1、ABSTRACTCINisthethirdmostcommoncauseofhospital-acquiredkidneyfailure，itisassociated诵thadverseclinicaloutcomes，prolongationofhospitalization，increasedmedicalcarecostsandincreasedriskofdeath．Thepathophysiologyofcontrast-inducednephropathyarenotwellunderstood．Itishyp

2、othesizedthatrenalvasoconstrictionleadingtorenalmedullaryischemiaandadirecttoxiceffectofcontrastagentontubularepithelialcellsmaycauseCIN．Initially,thereisatransientvasodilationandincreaseinrenalbloodflowfollowedbyvasoconstrictionandareductioninrenalbloodflow,which

3、isproportionaltotheosmolalityoftheinjectedsubstance，whilerenalischemiawillinducethegenerationofoxygenfreeradicalsandoxidativestress．Inaddition，theviscosityandhighpermeabilityofthecontrastagentwilldecreaserenalbloodflowandgeneratetherenalvascularthrombosis，deterior

4、atingtherenalfunction．Manystudieshavelookedattheuseofdifferenttreatmentmodalitiestoreducetheincidenceorlevelofrenalimpairmentincurred．Onlyperiproceduralhydration，minimizationofthevolumeofcontrastagentandcarefulutilizationofnephrotoxicdrugshavebeenshowntobeprotecti

5、ve．Studieswithothertreatment，suchashemoflltration，fenoldopam，furosemide，dopamine，mannitol，calciumchannelblockers，andatrialnattiureticpeptide，haveshownmixedresults，requitinglargerstudiestofurtherconfirm．N-acetylcysteine(NAC)isadirectscavengeroffreeradicals，itisalso

6、aprecursorforthesynthesisofglutathione(GSH)，whichisapowerfulantioxidantwithactivityagainstfleeradicals．NACcanimprovebloodflowthroughstabilizingnitricoxide．NACpossessesbothvasodilatoryandantioxidativeproperties，whicharethoughttoprovideprotectionagainstCIN．However,p

7、harmacokineticstudieshaveconfirmedthatthebioavailabilityoforalNACislow,rangingfrom4％to1O％．mainlyduetothefirst—passhepaticmetabolism，suggeststhatonlyasmallproportionoftheadministereddoseisavailableforrenalprotection．Duetothesubstantiallydifferentpharmacokineticandp

8、harmacodynamicprofilesbetweenintravenousandoralNAC，ithasbeensuggestedthattheintravenousformofNACmaybemoreeffectiveinpreventingCIN．However,afewstudiesfoc