造影剂对慢性肾功能不全患者肾功能的影响

Effects of Contrast Media on Renal Function in Patients with Chronic Renal Insufficiency

目的:了解造影剂对慢性肾功能不全患者肾功能的影响以及还原型谷胱甘肽(GSH)对造影剂肾损害的预防作用。方法:选择 2004年3月-2005年3月间,行肾动脉CT血管造影(CTA)检查的慢性肾功能不全患者共80例为研究对象,慢性肾功能不全定义为 SCr>120 μmol／L或Ccr<60 ml／min,所有患者均应用低渗非离子造影剂。80例患者随机分为对照组41例和GSH组39例。对照组从行CTA检查当日起予以生理盐水500 ml静脉滴注,每天1次,连用3 d;GSH组则在检查当日以还原型谷胱甘肽注射液1 800 mg 加入生理盐水500 ml静脉滴注,每天1次,连用3 d。造影剂肾病(CIN)诊断标准为造影后72 h内SCr升高0．5 mg／dl(44.2μmol／L) 或较基础值上升25％。结果:80例患者中发生CIN 10例,CIN发生率为12．5％,其中GSH组CIN发生率7．7％,对照组为17．0％,但两组比较尚无显著差异(P=0．205)。对照组造影后第1、2、3d SCr均较基础值显著上升(P<0．05);GSH组造影后3 d SCr与基础值相比,均无明显差异(P>0．05)。结论:慢性肾功能不全患者行肾动脉CTA造影剂肾病发病率为12．5％,GSH可有效预防造影剂引起的肾损害。

Objective： To analyze the impact of contrast media on renal function in patients with chronic renal insufficiency and study the preventive effects of exogenous reductive glutathione （GSH） to renal injury induced by contrast media. Methods： From March,2004 to March,2005, 80 patients with chronic renal insufficiency（SCr〉 120μmol/L or CCr 〈60ml/min） undergoing renal arteries CT angiography （CTA） were enrolled. Patients were randomly assigned into control group （n=41） and GSH group （n=39）. In control group , 0.9% saline 500ml was given intravenously once daily for 3 days from the day undergoing CTA procedures. Meanwhile, in GSH group at the dose of 1800mg GSH dissolved in 0.9% saline 500ml was administered once daily for 3 days. All patients received low-osmolality nonionic contrast agent. CIN is defined as an increase in serum creatinine more than 0. 5mg/dl （44. 2μmol/l） or 25% increase over the baseline serum creatinine level within 72h of contrast exposure. Results： Of 80 patients, there were 55 males and 25 females with an average age of 57. 5 ＋ 10. 8 years （28-80 years）. CIN occurred in 10/80 patients （12. 5%） in all patients with 3/39 patients （7%） in GSH group and 7/41 （17%） patients in controll group, but no significant difference found between the two groups （P=0. 205）. SCr in control group at 1st, 2nd and 3rd day post CTA were all significantly higher than the baseline （P〈0. 05）. In GSH group, SCr in day 1 to day 3 post CTA had no difference compared with the baseline （P〉0. 05）. Conclusion.. The incidence of CIN in the procedure of renal arteries CTA on chronic renal insufficiency patients was 12.5%. GSH could prevent renal injury induced by contrast media effectively.