Effectiveness of theophylline prophylaxis of renal impairment after coronary angiography in patients with chronic renal insufficiency
Effectiveness of theophylline prophylaxis of renal impairment after coronary angiography in patients with chronic renal insufficiency
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DOI：
10.1016/s0002-9149(03)00259-5
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发表时间：
2003-05-15
影响因子：
2.8
通讯作者：
Classen, M
中科院分区：
文献类型：
--
作者：
Huber, W;Schipek, C;Classen, M
造影剂可导致肾损害，导致住院时间延长和死亡率增加。腺苷是造影剂肾病（CIN; 48小时内血清肌酐升高≥ 0.5 mg/dl）的重要介质。因此，本研究的目的是探讨腺苷拮抗剂茶碱是否能降低冠状动脉造影后CIN的发生率。我们还描述了冠状动脉造影后CIN的危险因素。100例血清肌酐浓度大于或等于1.3 mg/dl的患者在冠状动脉造影前30分钟随机接受200 mg IV茶碱或安慰剂（造影剂量大于或等于100 ml）。接受茶碱治疗的患者和对照组患者在基线肌酐水平（平均值+/- SD）（1.65 +/- 0.41 vs 1.72 +/- 0.69 mg/dl）和造影剂用量（235 +/- 89 vs 261 +/- 139 ml）方面具有可比性。茶碱显著降低CIN的发生率（4% vs 20%，p = 0.0138）。在安慰剂组中，肌酐在造影剂给药后12小时（1.82 +/- 0.79 mg/dl，p = 0.0057）、24小时（1.90 +/- 0.86 mg/dl，p = 0.0001）和48小时（1.90 +/- 0.89 mg/dl，p = 0.0007）显著升高。使用茶碱预处理，平均肌酐仅在造影剂给药后24小时增加（1.70 +/- 0.40 mg/dl，P = 0.029），但在造影剂给药后12小时（1.65 +/- 0.43 mg/dl，p = 0.99）和48小时（1.65 +/- 0.41 mg/dl，p = 0.99）保持稳定。以下参数与造影剂诱导的肾损害显著相关：阿氏商数>5（造影剂[毫升] x血清肌酐/体重[kg]）、肌钙蛋白T升高、造影剂>300 ml和急诊血管造影。总之，茶碱可降低接受冠状动脉造影术的慢性肾功能不全患者的CIN发生率。特别是在接受大量造影剂的患者中，以及在具有动脉粥样硬化、商>5和/或肌钙蛋白T水平升高的患者中，应使用该方法。(C)2003年，Excerpta Medica，Inc.
Contrast media can lead to renal impairment that results in longer hospitalization and increased mortality. Adenosme is a crucial mediator of contrast-induced nephropathy (CIN; an increase in serum creatinine of greater than or equal to0.5 mg/dl within 48 hours). Therefore, it was the purpose of our study to investigate whether the adenosine antagonist theophylline reduces the incidence of CIN after coronary angiography. We also characterized risk factors for CIN after coronary angiography. One hundred patients with serum creatinine concentrations of greater than or equal to1.3 mg/dl randomly received 200 mg IV theophylline or placebo 30 minutes before coronary angiography (amount of contrast medium greater than or equal to100 ml). Patients who received theophylline and the controls were comparable with regard to baseline creatinine levels (means +/- SD) (1.65 +/- 0.41 vs 1.72 +/- 0.69 mg/dl) and the amount of contrast medium received (235 +/- 89 vs 261 +/- 139 ml). Theophylline significantly reduced the incidence of CIN (4% vs 20%, p = 0.0138). With placebo, creatinine significantly increased at 12 (1.82 +/- 0.79 mg/dl, p = 0.0057), 24 (1.90 +/- 0.86 mg/dl, p = 0.0001), and 48 hours (1.90 +/- 0.89 mg/dl, p = 0.0007) after administration of contrast medium. With pretreatment with theophylline, mean creatinine only increased 24 hours after contrast medium administration (1.70 +/- 0.40 mg/dl, P = 0.029), but was stable 12 hours (1.65 +/- 0.43 mg/dl, p = 0.99) and 48 hours after contrast medium administration (1.65 +/- 0.41 mg/dl, p = 0.99). The following parameters were significantly associated with contrast-induced renal impairment: Cigarroa quotient >5 (contrast medium [milliters] x serum creatinine/body weight [kg]), elevated troponin T, >300 ml of contrast medium, and emergency angiography. In conclusion, theophylline reduces the incidence of CIN in patients with chronic renal insufficiency undergoing coronary angiography. It should be used especially in patients receiving large amounts of contrast medium, and in patients with a Cigarroa, quotient of >5 and/or elevated troponin T levels. (C) 2003 by Excerpta Medica, Inc.