高渗及低渗造影剂对儿童肾脏功能影响的临床研究

Influence of high- and low-osmolality contrast media on renal function in children

目的初步探讨高渗及低渗造影剂对儿童肾脏功能的影响,以及水化对造影剂相关性肾病(CAN)的预防作用。方法将行静脉肾盂造影或增强CT检查的患儿分为高渗造影剂组(HOCM)27例和低渗造影剂组(LOCM)33例,各组患儿随机分为水化组和非水化组。水化组于造影后立即给予1/5张含钠维持液20ml/kg于3h内静脉滴入,非水化组不给予静脉补液。结果(1)HOCM组造影前,非水化组与水化组相比,SCr、Ccr差异均无统计学意义。造影后,HOCM非水化组SCr[(59·71±12·49)μmol/L]较造影前[(49·91±6·09)μmol/L]显著增高(P<0·05),而Ccr造影后[(71·33±7·51)ml/(min·1·73m2)]较造影前[(97·81±15·10)ml/(min·1·73m2)]明显降低(P<0·05);HOCM水化组SCr、Ccr在造影前、后差异无统计学意义(P>0·05)。HOCM非水化组有3例(23·1%,3/13)发生CAN,HOCM水化组无1例发生CAN(P>0·05)。(2)LOCM水化和非水化组造影前、后SCr、Ccr差异均无统计学意义。LOCM非水化组CAN发生率为6·7%(1/15),LOCM水化组11·1%(2/18)(P>0·05)。(3)HOCM非水化组与LOCM非水化组相比,造影后SCr显著升高(Z=-2·42,P<0·05),而Ccr降低(Z=-2·83,P<0·05)。(4)HOCM与LOCM组共计6例CAN在2周内SCr及Ccr恢复至造影前水平。结论(1)肾功能正常的儿童应用高渗或低渗造影剂均可发生可逆的造影剂肾病;(2)高渗造影剂对儿童血肌酐及肌酐清除率的影响大于低渗造影剂;(3)水化可减轻高渗造影剂对儿童肾脏功能的损害;(4)儿童应用低渗造影剂水化后仍可发生CAN。

Objective To compare the effects of different contrast media on the renal function in children, and to investigate the prophylactic efficacy of hydration. Methods Sixty patients on whom either intravenous pyelography （IVP） or enhanced CT scan was required were divided into high osmolality contrast media （HOCM） group （n =27） and low osmolality contrast media （LOCM） group （n =33）, and each group was randomly subdivided into hydration group （HG） and non-hydration group （ NHG）. In HOCM group, HG had 14 cases and NHG had 13 cases; while in LOCM group, HG had 18 cases and NHG had 15 cases. A 1/5-tonic solution at a dose of 20 ml/kg was intravenously given immediately after the exposure to a contrast medium within 3 hours in the HG, while the NHG cases were not given any infusion. Results There were no significant difference between HG and NHG in baseline serum creatinin （SCr） and creatinin clearance （Ccr）. After exposure, in HOCM group, SCr of NHG （59. 71±12. 49）μmol/L significantly increased as compared with baseline （49. 91±6. 09）μmol/L （P 〈0. 05） , while Ccr （97. 81 ±15.10） ml/ （min·1.73m^2） decreased compared with baseline （71.33 ±7.51） ml/（min·1.73m^2）（p〈0.05）. No significant changes of SCr and Ccr were observed in the HG before （48. 37±7.11）μmol/L, （99.81±15.41）ml/（min·1.73m^2） and after （49.63±6.84）μmol/L, （88.29±12.75） ml/（min·1.73 m^2） （ P 〉 0.05 ） the exposure to contrast medium. Contrast medium-asseciated nephropathy （CAN） was found in 3 cases in NHG（23.1% ,3/13） but none in HG （P〉0.05）. In the LOCM group, there was no significant difference in SCr and Ccr before and after the exposure to the contrast media. The incidence of CAN was 6. 7% （1/15） in the NHG and 11.1% （2/18） in the HG（P 〉 0.05）. The average increase of SCr in HOCM group was significantly higher than that in LOCM group （ Z= -2.42, P 〈 0. 05 ）. The average decrease of Ccr in HOCM group was significantly higher than that in LOCM group （ Z=- 2. 83, P 〈 0. 05 ） . The SCr and Ccr of the 6 CAN cases in beth HOCM and LOCM groups returned to baseline level within 2 weeks. Conclusions （ 1 ） Children can develop reversible CAN after the exposure to high or low osmolality contrast medium. （2） The high osmolality contrast medium seemed to have more serious toxicity in renal function than low osmolality contrast medium. （3） The prophylactic use of hydration can effectively prevent CAN in patients who will expose to high osmolality contrast medium. （4） Children can develop reversible CAN after the exposure to low osmolality contrast medium even after hydration.