等渗及低渗造影剂对高危患者发生造影剂肾病的比较

Influences of an iso-osmolar versus a low-osmolar contrast media on radiographic contrast nephropathy in high-risk patients

目的:糖尿病和肾功能受损能增加低渗造影剂诱导的肾毒性事件的风险,为验证高危患者使用等渗二聚体非离子型造影剂碘克沙醇的安全性,对比观察碘克沙醇与低渗非离子型造影碘普罗胺对高危患者造影剂肾病发生的影响。方法:①药物:等渗二聚体非离子型造影剂碘克沙醇,商品名威视派克320,含碘320g/L,渗透浓度290mmol/kg,爱尔兰GE Healthcare生产,批号10551022 10330922;低渗非离子型造影剂碘普罗胺,商品名优维显370,含碘370g/L,渗透浓度770mmol/kg,广州先灵公司生产,批号7283444326。②分组处理:收集2005-05/2007-05抚顺市中心医院心内科收治患糖尿病且血清肌酐水平增高的高危患者87例,随机分为两组,分别采用碘克沙醇与碘普罗胺进行冠状动脉造影诊疗。③观察指标:造影后3d内血清肌酐峰值水平,血清肌酐水平增高44.2μmol/L或更多及88.4μmol/L的比例,造影后7d内肌酐平均水平改变;副性事件数量。结果:87例均进入结果分析。①血清肌酐水平变化:造影后3d内肌酐的峰值水平碘克沙醇组少于碘普罗胺组(P<0.05);血清肌酐水平增高≥44.2μmol/L者碘克沙醇组有1例,而碘普罗胺组有11例,碘普罗胺组还有7例血清肌酐水平增高≥88.4μmol/L;造影后7d肌酐增高平均值碘克沙醇组少于碘普罗胺组(P<0.05)。②副性事件:碘克沙醇组1例、碘普罗胺组6例发生严重副性事件,碘普罗胺组6例中4例患者恢复,1例死亡,1例发展为慢性肾功能衰竭。结论:与低渗非离子型造影剂碘普罗胺相比,高危患者使用等渗二聚体非离子型造影剂碘克沙醇进行冠脉介入诊疗能明显减少造影剂肾病的发生。

AIM： Diabetes mellitus and renal dysfunction can cause the nephrotoxic effects induced by low-osmolar contrast media. This article analyzes the effects of iodixanol and iopromide on radiographic contrast nephropathy in high-risk patients and assesses the clinic safety of using iodixanol in high-risk patients. METHODS： ①There are iodixanol, tradename Visipaque320, containing 320 g/L iodine, with the osmotic concentration of 290 mmol/kg, GE Healthcare Ireland, batch number 10551022 10330922, and iopromide, tradename Ultravist370, containing 370 mg/mL iodine, with the osmotic concentration of 770 mmol/kg, Guangzhou Xianling Company, batch number 72834 44326. ②Eighty-seven diabetes mellitus patients with increased serum creatinine level were enrolled at the Department of Cardiology of Fushun Central Hospital from May 2005 to May 2007. The patients were randomly divided into two groups, and were respectively treated with iodixanol and iopromide for coronary arteriography. ③The peak of serum creatinine level and the ratio of the increase in the creatinine level of 44.2 μmol/L or more and the increase of 88.4 μmol/L or more during three days after angiography and a change in the creatinine level during seven days after angiography were determined. Side effects were observed. RESULTS： Eighty-seven patients were involved in the result analysis. ①The serum creatinine level increased significantly less in patients in the iodixanol group than in the iopromide group （P 〈 0.05）. One patients had an increase in serum creatinine level of 44.2 μmol/L or more in the iodixanol group, and 11 patients in the iopromide group. Seven patients had an increase in serum creatinine level of 88.4 μmol/L or more in the iopromide group. The mean change in the creatinine level in the iodixanol group was less than that in the iopromide group 7 days after angiography （P 〈 0.05）. ②Severe side effects occurred in one patient of the iodixanol group and six patients of the iopromide group. Of the six patients of the iopromide group, four patients recovered, one died and one developed chronic renal failure. CONCLUSION： Nephropathy induced by contrast media may be less likely to develop in high-risk patients when iodixanol is used, rather than a low-osmolar, nonionic contrast media iopromide.