摘要
目的探讨冠心病合并肾功能不全患者应用维生素C预防对比剂肾病的安全性和临床疗效。方法本研究为单中心前瞻性随机对照临床试验,连续入选132例血清肌酐≥11 mg/L(97.2μmol/L)的冠心病患者,随机分为两组。干预组(n=70)在水化基础上于造影前经静脉予维生素C 3 g及造影后口服维生素C 0.5 g一天两次,连服2 d;对照组(n=62)仅生理盐水水化;所有患者均于术前及术后接受常规水化,观察术后患者的肾功能及心血管事件。结果维生素C干预组与对照组,在主要终点指标即术后48 h内血清肌酐峰值变化上,两组之间无显著性差异(0.2±1.7 mg/L vs 0.3±2.2 mg/L,P=0.625);在次要终点即对比剂肾病的发病率上,维生素C干预组较对照组低,但无显著性差异(5.6%vs 8.1%,P=0.594)。两组患者在院内临床预后及住院时间上无明显差异。结论对于合并肾功能不全的冠心病患者短程应用大剂量维生素C有降低对比剂肾病发生的趋势,但与对照组相比差异无统计学意义,维生素C预防对比剂肾病的有效性尚需大样本临床试验来证实。
Objective To evaluate the safety and efficacy of vitamin C for reducing the risk of contrast-induced nephropathy（CIN） in coronary heart discease（CHD） patients with renal insufficiency.Methods We conducted a single-center,prospective,randomized,controlled trial,involving 132 CHD patients with stable serum creatinine levels of at least 11 mg/L（≥97.2 μmol/L）.Patients were randomized to vitamin C（n=70） 3 g intravenous injection before the procedure and oral 1g per day for 2 days after the procedure,vitamin C group） or sodium chloride alone（n=62,control group）.All patients received pre-and postprocedure hydration.Results There was no difference between vitamin C group and control group in mean peak increase in serum creatinine measured within 48 hours after coronary angiography,the primary study end point（0.2±1.7 mg/L vs 0.3±2.2 mg/L,P=0.625）.The incidence of CIN,a secondary end point defined as increase of either ≥25% or ≥5 mg/L in serum creatinine,was 5.6% in vitamin C-treated patients（4/70） and 8.1% in control group patients（5/62）,a nonsignificant difference（P=0.594）.There were also no differences between the 2 groups in the inhospital clinical outcomes or length of hospital stay.Conclusion Short-term application of high-dosage vitamin C has a trend of lowering CIN in CHD patients with renal insufficiency,but is not significantly different from control group.The efficacy of vitamin C in p revention of CIN needs large sample trials to confirm.
出处
《临床和实验医学杂志》
2011年第3期176-178,共3页
Journal of Clinical and Experimental Medicine
关键词
血管造影
对比剂肾病
维生素C
Angiography
Contrast-induced nephropathy
Vitamin C
