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目的观察N-乙酰半胱氨酸(N-acetylcysteine,NAC)对肾功能正常或轻度肾功能不全的老年糖尿病患者造影剂肾病的预防作用。方法拟采用低渗造影剂进行增强CT检查70例年龄>60岁、糖尿病史1a以上的正常或轻度肾功能不全患者,随机分为NAC组与对照组各35例,NAC组造影前1d及造影后连续2d口服NAC,600mg/次;2组均给予水化治疗;比较造影前和造影后24,48h2组血肌酐、尿素氮和血胱抑素C水平及造影剂肾病发生率。结果 NAC组无造影剂肾病发生,对照组发生造影剂肾病2例,2组比较差异无统计学意义(P>0.05);增强CT检查后48h,NAC组血肌酐、尿素氮和血胱抑素C水平低于对照组,估测肾小球滤过率水平高于对照组(P<0.05)。结论 NAC联合水化治疗对肾功能接近正常的老年糖尿病患者造影剂肾病有一定预防作用。
Objective To investigate the preventive effect of N-acetylcysteine (NAC) on contrast-induced nephropathy in elderly diabetic patients with normal renal function or with mild renal insufficiency. Methods 70 patients with normal or mild renal dysfunction who were over 60 years old and had a history of diabetes more than 1a were randomly divided into 35 cases in NAC group and control group, The rats in each group were given hydration therapy for 2 days continuously after 2-day radiography. The serum creatinine, blood urea nitrogen, serum total cystatin C and the incidence of contrast-induced nephropathy were compared before and 24 and 48 hours after radiography. Results There was no contrast agent nephropathy in the NAC group and contrast agent nephropathy in the control group. There was no significant difference between the two groups (P> 0.05). At 48h after enhanced CT examination, serum creatinine, urea nitrogen and serum cystatin C levels were lower than the control group, estimated glomerular filtration rate was higher than the control group (P <0.05). Conclusion NAC combined with hydration therapy has some preventive effects on contrast-induced nephropathy in elderly diabetic patients with normal renal function.