造影剂对冠脉造影患者肾功能的影响

目的了解造影剂进行冠状动脉造影时对肾功能的影响。方法前瞻性观察了141例应用非离子型低渗性造影剂碘海醇或等渗性造影剂碘克沙醇进行冠状动脉造影患者的肾功能变化,于造影前、造影后第1天、第2天分别测定血尿素氮(BUN)、血肌酐(SCr)、血胱抑素C(cystatinC,CysC)、尿微量白蛋白(mALB)、尿转铁蛋白(TRF)、α1-微球蛋白(α1-MG)、N-乙酰基-β-D氨基葡萄糖苷酶(NAG)及肌酐。结果与造影前比较,造影后第1天血CysC显著升高(P<0.01),超过正常范围,造影后第2天血CysC仍高于造影前水平(P<0.01),但已降至正常范围;与造影后第1天比较,造影后第2天血CysC显著下降(P<0.01)。血BUN、SCr及电解质造影前后无显著变化;与造影前比较,造影后第1天mALB、TRF、α1-MG和NAG均显著升高(P<0.01),超过正常范围,造影后第2天,NAG仍显著高于造影前(P<0.01),α1-MG仍高于造影前(P<0.05),mALB和TRF恢复到造影前水平(P>0.05);与造影后第1天比较,造影后第2天mALB明显下降(P<0.05),TRF、α1-MG和NAG均显著降低(P<0.01)。结论在无基线肾功能不全患者中,未见造影后发生CIN的病例,部分患者存在一过性轻度蛋白尿、尿酶升高;年龄与糖尿病可能是影响造影后第1天血CysC变化的主要危险因素。

Objective To investigate the effects of contrast media on renal functions of the patients undergoing coronary angiography. Methods 141 hospitalized patients undergoing comnary angiography were selected. Serum ereatinine, BUN, and cystatin C levels were assessed at start, 1 day and 2 days after the administration of a radioeontrast agent. Furthermore, urinary mALB, TRF, α1- MG, NAG and creatinine were checked for evidence of tubular or glomerular damage at start, 1 day and 2 days after the administration of a radiocontrast agent. Results In comparison with the value before coronary angiography, senum cystatin C significantly increased at 1 - day after angiography（ P 〈 0.01） and exceeded nonnal limits, senan cystatin C still increased at 2 - day after angiography（ P 〈 0.01 ） but fell into nonnal limits. In comparison to the 1 - day levels taken after angiography, eystatin C significantly decreased at 2- day after angiography（P 〈 0.01）. There was no significant change compared to baseline in BUN, sennn creatinine, Na ＋, K ＋ and C1 - levels after angiography. In cemparison with the value before coronary angiography, urinary mALB, TRF, α1- MG and NAG significantly increased at 1 - day after angiography （P 〈 0.01） and exceeded normal limits, urinary NAG significantly increased at 2 - day after angiography（ P 〈 0.01）, urinary α1- MG still increased at 2 - day after angiography （ p 〈 0.05）, but fell into nonnal limits, urinary mALB and TRF levels at 2 - day after sngiography hed no significant change compared to baseline（ P 〉 0.05） ; in comparison to the 1 - day levels taken after angiography,,xinary TRF, α1- MG and NAG significantly decreased at 2 - day after angiography（ P 〈 0.01 ）, uriruuy mALB obviously decreased at 2 - day after anglography （ P 〈 0.05）. Conclusion In patients without baseline renal failure,no CIN occurred. In part of them,there is light increase in urinary protein and enzyme; diabetes mellitus and age may be the major risk factors affecting the change in eyststin C at 1 - day after angiography.