Folic Acid Attenuates Contrast-Induced Nephropathy in Patients With Hyperhomocysteinemia Undergoing Coronary Catheterization: A Randomized Controlled Trial.
Folic Acid Attenuates Contrast-Induced Nephropathy in Patients With Hyperhomocysteinemia Undergoing Coronary Catheterization: A Randomized Controlled Trial.
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叶酸可减轻接受冠状动脉导管插入术的高同型半胱氨酸血症患者对比剂诱发的肾病：一项随机对照试验
DOI：
10.3389/fcvm.2021.707328
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发表时间：
2021
影响因子：
3.6
通讯作者：
Peng H
中科院分区：
文献类型：
--
作者：
Peng L;Shui X;Tan F;Li Z;Ling Y;Wu B;Chen L;Li S;Peng H
背景：高同型半胱氨酸血症是造影剂肾病的危险因素。叶酸可以减轻大鼠的这种肾病。叶酸对造影剂诱导的肾病的保护作用在人类中还没有研究。本研究旨在探讨叶酸对高同型半胱氨酸血症患者冠状动脉插管术后造影剂肾病(CIN)发生率的影响。方法：这是一项单中心、前瞻性、双盲、随机对照试验(ClinicalTrials.gov，NCT02444013)。入选2015年5月至2018年8月接受冠状动脉造影术或经皮冠状动脉介入治疗的血浆同型半胱氨酸≥15μM患者412例，平均年龄(65±12)岁，男性268例。患者被随机分为两组：治疗组203例，入选后即刻口服叶酸5 mg，3次/d，连续72h；对照组209例，服用安慰剂。造影剂肾病定义为造影剂注射后48或72小时内血肌酐升高25%或44μM。结果：50例(12%)患者在导尿后48h后发生CIN，其中治疗组16例(8%)，对照组34例(16%)(P=0.009)。同时，53例(13%)患者在术后72 h发生CIN，其中治疗组18例(9%)，对照组35例(17%)(P=0.017)。治疗组造影剂肾病发生率低于对照组(P=0.017)。Logistic回归分析证实，叶酸是造影剂肾病的保护因素(RD=0.0788，95%CI：0.0105~0.1469，P=0.019)。我们没有发现与叶酸相关的严重不良反应。两组均未发生死亡或血液透析。结论：高同型半胱氨酸血症患者围手术期应用叶酸可降低冠状动脉插管术后造影剂肾病的发生率。临床试验注册：ClinicalTrials.gov，标识符[NCT02444013]。
Background: Hyperhomocysteinemia is a risk factor for contrast-induced nephropathy. Folic acid can attenuate such nephropathies in rats. The protective effect of folic acid against contrast-induced nephropathy has not been studied in humans. We aimed to investigate the effect of folic acid on the incidence of contrast-induced nephropathy (CIN) after coronary catheterization in patients with hyperhomocysteinemia. Methods: This was a single-center, prospective, double-blind, randomized controlled trial (ClinicalTrials.gov, NCT02444013). In total, 412 patients (mean age: 65 ± 12 years, 268 male) with plasma homocysteine ≥15 μM, who underwent coronary arteriography (CAG) or percutaneous coronary intervention (PCI) from May 2015 to August 2018, were enrolled. Patients were randomly assigned to two groups: a treatment group (n = 203), taking 5 mg of folic acid (orally, three times/day) immediately after enrollment and for 72 h after operation, and a control group (n = 209), taking placebo. Contrast-induced nephropathy was defined as an increase in serum creatinine of >25% or 44 μM within 48 or 72 h after contrast medium administration. Results: In total, 50 (12%) patients developed CIN after 48 h after catheterization, including 16 (8%) in the treatment group and 34 (16%) in the control group (P = 0.009). Meanwhile, 53 (13%) patients developed CIN after 72 h of CAG/PCI, including 18 (9%) in the treatment group and 35 (17%) in the control group (P = 0.017). The incidence of contrast-induced nephropathy in the treatment group was lower than that in the control group (P = 0.017). Logistic regression analysis confirmed that administration of folic acid was a protective factor against contrast-induced nephropathy (RD = 0.0788, 95%CI: 0.0105–0.1469, P = 0.019). We found no serious adverse events associated with folic acid. No death or hemodialysis occurred in either group. Conclusions: Perioperative administration of folic acid attenuates the incidence of contrast-induced nephropathy after coronary catheterization in patients with hyperhomocysteinemia. Clinical Trial Registration: ClinicalTrials.gov, identifier [NCT02444013].