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目的 :研究培哚普利和氨氯地平对放射造影剂肾毒性的保护作用 ,并探讨一氧化氮 (NO)在造影剂肾毒性发病机制中的作用。 方法 :2 97例静脉肾盂造影患者被随机分为 3组 ,即氨氯地平组、培哚普利组和对照组。注射 76 %泛影葡胺前 1h ,双盲法随机分别单次获得氨氯地平 (5mg)、培哚普利 (4mg)或安慰剂 ,造影前 2 4h和造影后 4 8h抽血检测血清肌酐 (SCr) ,并检测造影前后 2 4h尿中NO ,白蛋白 ,N 乙酰基 β 氨基葡萄糖苷酶 (NAG)及视黄醇结合蛋白 (RBP)水平。造影后 4 8hSCr较基础值增高 2 5 %或 4 4 2 μmol/L定义为造影剂肾毒性。 结果 :安慰剂组患者尿中白蛋白、RBP、NAG水平显著升高 (P <0 0 5 ) ,NO水平显著降低 (P <0 0 5 ) ;造影后 4 8hSCr水平增高 (P<0 0 5 )。培哚普利组SCr、尿中NO、白蛋白、NAG和RBP的水平均无明显变化 (P >0 0 5 )。氨氯地平组SCr、尿NO和RBP的水平亦无明显变化 (P >0 0 5 )。但尿NAG水平增高 (P <0 0 5 )。氨氯地平和培哚普利组尿RBP水平和造影剂肾毒性发生率均较对照组低 (P <0 0 5 )。 结论 :患者造影前口服单剂量氨氯地平或者培哚普利对造影剂肾毒性有一定预防作用 ,NO可能在造影剂肾毒性发病机制中起重要作用。
OBJECTIVE: To study the protective effect of perindopril and amlodipine on nephrotoxicity induced by radioactive contrast medium and to explore the role of nitric oxide (NO) in the pathogenesis of contrast nephrotoxicity. Methods: A total of 2 97 patients with intravenous pyelography were randomly divided into 3 groups: amlodipine group, perindopril group and control group. One hour before injection of 76% diatrizoate meglumine, the patients were randomized to receive amlodipine (5 mg), perindopril (4 mg) or placebo in a double-blind randomized trial. Serum creatinine was measured at 24 h before angiography and 48 h after angiography (SCr), and the levels of NO, albumin, N-acetylglucosaminidase (NAG) and retinol binding protein (RBP) in urine were measured 24 hours before and after contrast. 48 h SCr 48 h after radiography increased 25% or 442 μmol / L more than the baseline value as a contrast agent nephrotoxicity. Results: Urinary albumin, RBP and NAG levels were significantly increased (P <0 05) and NO levels were significantly decreased (P 0 05) in the placebo group compared with those in the placebo group ). There was no significant change in SCr, urine NO, albumin, NAG and RBP in perindopril group (P> 0.05). The levels of SCr, urinary NO and RBP in the amlodipine group also did not change significantly (P> 0.05). However, urinary NAG levels increased (P <0 05). Amlodipine and perindopril urinary RBP levels and contrast agent nephrotoxicity were lower than the control group (P <0 05). CONCLUSION: A single oral dose of amlodipine or perindopril before angiography can prevent nephrotoxicity of contrast medium. NO may play an important role in the pathogenesis of contrast nephrotoxicity.