造影剂的肾毒性:离子型与非离子型造影剂对比研究

Nephrotoxicity of contrast media: Comparison between ionic and nonionic contrast media

目的 :对离子型与非离子型造影剂的肾毒性作用进行前瞻性对比研究。方法 :将 1 6 0例使用造影剂的患者分成两大类 :肾功能正常 (A组 )和肾功能轻度损害 (B组 ) ,其中 A组患者 90例 ,B组患者 70例。检测所有患者使用造影剂前2 4 h及使用后 2 4 h、4 8h、72 h血清和尿的肌酐与 β2 -微球蛋白含量。结果 :1 A组患者使用离子型造影剂后 2 4 h和 4 8h血清和尿的肌酐、β2 -微球蛋白均有不同程度升高 ,它们与基础值的差异有极显著的统计学意义 (P<0 .0 1 ) ,72 h后各项指标大致恢复到基础值水平 (P>0 .0 5 )。使用非离子型造影剂后 2 4 h、4 8h、72 h血清和尿的肌酐及β2 -微球蛋白与基础值比较均没有明显的改变 (P>0 .0 5 )。2 B组患者使用离子型造影剂后 2 4 h血清肌酐和 β2 -微球蛋白升高 ,与基础值的差异有极显著的统计学意义 (P<0 .0 1 ) ,持续至 72 h后未能恢复至基础值水平 (P<0 .0 5 )。使用非离子型造影剂的患者造影后 2 4 h、4 8h、72 h血肌酐和 β2 -微球蛋白水平的变化与基础值比较没有统计学的差异 (P>0 .0 5 )。结论 :大剂量离子型造影剂对肾脏有一过性损伤 ,但这种损伤在短期内可恢复 ;对于肾功能有轻度损害的患者使用非离子型造影剂较离子型造影剂更安全 。

Objective: To evaluate the nephrotoxic effects of ionic contrast media (ICM)and nonionic contrast media (NCM). Methods: ICM and NCM was compared in 160 patients undergoing enchanced CT scan in a prospective, randomized, double blind multicenter trial, 90 with normal renal function(NRF) were divided into two groups: using ICM and NCM,70 with slight impaired renal function(IRF) were divided into two groups:using ICM AND using NCM. A sample of fresh urine and a venous blood sample were obtained from all patients 24 hours before and 24 hours, 48 hours, 72 hours after used contrast media to determine serum creatinine and β 2 microglobulin, urinary creatinine and β 2 microglobulin. Results: ①serum creatinine and β 2 microglobulin,urinary creatinine and β 2 microglobulin after 24h and 48h in patients with NRF using ICM were increased. There was a statistically significant difference between the values before 24h and 24h, 48h after using CM. But the values 72h after was come back basic values. There was not a statistically significant difference between the values before and after using NCM in patients with NRF.②serum creatinine and β 2 microglobulin after 24h and 48h in patients with NRF using ICM were increased ( P <0.01). The values 72h after was not come back basic values. There was not a statistically significant difference between the values before and after using NCM in patients with IRF ( P <0.01). Conclusion:These findings suggest that the large dose of ICM has brief lesion to kidney. Using NCM has more safety and toleration to patients with INF.