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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 ,双盲法随机分别给予氨氯地平 (5mg)、培哚普利 (4mg)或安慰剂 ,造影前 2 4h和造影后 4 8h测内生肌酐清除率 (CrCl) ,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)含量。造影后 4 8h血清肌酐较基础值增高 2 5 %或 0 .5ml/dl定义为造影剂肾毒性。结果 安慰剂组尿中白蛋白、RBP、NAG显著升高 (P <0 .0 5 ) ,NO显著降低 (P <0 .0 5 ) ;造影后 4 8hCcr下降 (P <0 .0 5 )。培哚普利组Ccr、尿中NO、白蛋白、NAG和RBP的含量均无明显变化 (P >0 .0 5 )。氨氯地平组Ccr ,尿NO和RBP的含量亦无明显变化 (P >0 .0 5 )。但尿NAG含量增高 (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 造影前口服单剂量氨氯地平或者培哚普利均能有效预防造影剂肾毒性 ,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 media and to explore the role of nitric oxide (NO) in the pathogenesis of contrast nephrotoxicity. METHODS: Two hundred and ninety-seven patients with intravenous pyelography were randomized into 3 groups: amlodipine, perindopril and control. One hour before the injection of 76% diatrizoate, double-blind randomized patients were given amlodipine (5mg), perindopril (4mg) or placebo, endogenous creatinine clearance 24 hours before contrast and 48 hours after contrast CrCl, and the content of NO, albumin, N - acetyl - β - glucosaminidase (NAG) and retinol binding protein (RBP) in urine of 24 hours before and after contrast were detected. 48h after contrast serum creatinine increased by 25% or 0.5ml / dl than the basic value as contrast agent nephrotoxicity. Results The urinary albumin, RBP, NAG in placebo group were significantly increased (P <0.05), NO was significantly decreased (P <0.05), and decreased 48 h after angiography (P <0.05). Periclipril group Ccr, urinary NO, albumin, NAG and RBP content had no significant change (P> 0.05). Amlodipine group Ccr, urinary NO and RBP content did not change significantly (P> 0.05). However, urine NAG increased (P <0.05). Amlodipine and perindopril group urinary RBP levels and contrast agent nephrotoxicity were lower than the control group (P <0. 05). Conclusion Before oral administration, single oral dose of amlodipine or perindopril can effectively prevent nephrotoxicity of contrast medium, and NO may play an important role in the pathogenesis of nephrotoxic contrast medium.