上海交通大学学报（医学版）

›› 2010, Vol. 30 ›› Issue (10): 1270-.doi: 10.3969/j.issn.1674-8115.2010.10.021

• 论著（临床研究） • 上一篇    下一篇

非离子型对比剂对冠状动脉造影患者肾功能的影响

叶 颖1, 方唯一1, 仇兴标1, 陈 晖1, 施鸿毓1, 宋 洁1, 任诗佳2   

  1. 1.上海交通大学附属胸科医院心内科, 上海 200030； 2.浙江台州市第一人民医院心内科, 台州 318020
  • 出版日期:2010-10-25 发布日期:2010-10-27
  • 通讯作者: 方唯一, 电子信箱: fwychest@163.com。
  • 作者简介:叶 颖(1973—), 男, 副主任医师, 学士；电子信箱: ye-ying@vip.163.com。

Effects of nonionic contrast medium on renal functions of patients undergoing coronary angiography

YE Ying1, FANG Wei-yi1, QIU Xing-biao1, CHEN Hui1, SHI Hong-yu1, SONG Jie1, REN Shi-jia2   

  1. 1.Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China；2.Department of Cardiology, The First People's Hospital, Taizhou 318020, China
  • Online:2010-10-25 Published:2010-10-27

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摘要：

目的 观察患者使用非离子型对比剂进行冠状动脉造影检查前后肾功能的变化。方法 收集2009年9月—2010年2月在上海交通大学附属胸科医院心内科使用非离子型对比剂行冠状动脉造影检查的556例（男性342例，女性214例）患者的资料。分别比较造影前后血液和尿液肾功能指标的变化，如果血清肌酐(Scr)绝对值水平升高>44.2 μmol/L或者较基础水平升高>25％，则定义为发生了对比剂肾病（CIN）。对CIN患者作进一步分析，筛选反映CIN的敏感指标。结果 血液肾功能常规检查显示，除胱抑素C(Cys C)以外，造影术前后患者的Scr、尿素氮(BUN)、尿酸(UA)和视黄醇结合蛋白(RBP)浓度比较差异均有统计学意义（P<0.05或P<0.01）；尿液肾功能指标检查显示，只有α1-微球蛋白(α1-MG)浓度在造影术前后有统计学意义（P<0.01）。共有39例（男性18例，女性21例）患者在造影术后发生了CIN，发病率为7.01％。其中尿α1-MG的变化最显著，增高（39.77±16.75）%。男性和女性CIN患者的内生肌酐清除率(Ccr)值均在正常范围，造影术前后比较差异无统计学意义（P>0.05）；而造影术前后肾小球滤过率(eGFR)差异均有统计学意义[男性（118.88±38.03）mL·min-1·1.73 m-2 vs （88.14±28.18）mL·min-1·1.73 m-2，女性（107.69±38.65） mL·min-1·1.73 m-2 vs（77.40±30.71）mL·min-1·1.73 m-2]（P<0.01）。CIN患者对比剂用量为（225.34±16.58）mL，高于无CIN患者的（201.56±13.27）mL，差异有统计学意义（P<0.01）。Logistic多元回归分析显示，与CIN发病相关的因素包括高血压、糖尿病、慢性肾功能不全和对比剂用量。结论 CIN患者在冠状动脉造影前后肾功能的变化均与注射非离子型对比剂有关；α1-MG是发生CIN的早期敏感指标。

关键词: 对比剂, 对比剂肾病, 冠心病, 冠状动脉造影

Abstract:

Objective To observe effects of nonionic contrast medium on renal functions of patients undergoing coronary angiography. Methods A total of 556 inpatients (342 males and 214 females) who had undergone coronary angiography with nonionic contrast medium in Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, from September 2009 to February 2010 were selected. The series of renal function indexes of blood and urine were measured and compared in all patients before and after the angiography. Contrast-induced nephropathy (CIN) was defined as the variation of the absolute value of serum creatinine (Scr) over 44.2 μmol/L or with a rise of 25% than basis. Further evaluation should be needed to screen sensitive markers of CIN in those patients. Results In renal function indexes of blood, there were significant differences of concentrations of Scr, blood urine nitrogen (BUN), uric acid (UA), and retinal-binding protein (RBP) before and after angiography except for cystain C (Cys C) (P<0.05 or P<0.01). In renal function indexes of urine, there was significant difference of concentrations of α1-microglobulin (α1-MG) before and after angiography (P<0.01). Thirty-nine patients (18 males and 21 females) accorded with the diagnostic criteria of CIN and the incidence was 7.01%. The variation of α1-MG was the most obvious one with a rise of (39.77±16.75)%. The level of Ccr was still within normal limits (P>0.05), but the variation of eGFR was significant [(118.88±38.03) mL·min-1·1.73 m-2 vs (88.14±28.18) mL·min-1·1.73 m-2 in males, (107.69±38.65) mL·min-1·1.73 m-2 vs (77.40±30.71) mL·min-1·1.73 m-2 in females](P<0.01). Compared to CIN group, the mean dosage of contrast medium was significantly different in non-CIN group [(225.34±16.58) mL vs (201.56±13.27) mL](P<0.01). The Logistic multivariate regression analysis showed that the factors causing CIN were hypertension, diabetes mellitus, chronic renal insufficiency, and the mean dosage of contrast medium. Conclusion The variations of these indexes of CIN patients before and after angiography were related to the injection of nonionic contrast medium. The α1-MG was an early sensitive marker of CIN.

Key words: contrast medium, contrast-induced nephropathy, coronary artery disease, coronary arteriongraphy