等渗与低渗造影剂对行冠状动脉介入诊治术肾功能不全患者肾毒性的对比研究

A comparison study on nephrotoxicity of isosmolar contrast media versus low-osmolar contrast media in patients with renal insufficiency undergoing coronary angiography or percutaneous coronary intervention

目的:对比研究肾功能不全患者行冠状动脉介入诊治术使用等渗造影剂与低渗造影剂所致肾病的发生率和严重程度。方法:2003年3月1日至2007年9月1日收治肾功能不全住院患者461例,患者分为2组:等渗造影剂组(131例)与低渗造影剂组(330例)。全部患者行冠状动脉介入诊治术前1 d、术后第1、3、7天检测2组患者血清肌酐(SCr),并观察2组不良反应发生情况。结果:术后第1、3、7天,等渗造影剂组所致肾病累计发生率分别为6.9%、19.1%与19.8%;低渗造影剂组分别为23.9%、36.4%与39.4%,等渗造影剂组肾病发生率均低于低渗造影剂组,差异有统计学意义(均P<0.05)。术后第1及第3天,等渗造影剂组SCr浓度升高分别为(-15.8±55.5)μmol/L及(12.3±58.0)μmol/L,而低渗造影剂组分别为(20.1±53.7)μmol/L及(38.3±62.4)μmol/L,2组间比较差异有统计学意义(均P<0.05)。结论:等渗造影剂对肾功能不全患者的肾毒性较低渗造影剂轻,肾功能不全患者行冠状动脉介入术时选用等渗造影剂更安全。

Objective： To compare the frequency and intensity of nephropathy of isosmolar contrast media with low-osmolar contrast media in patients with renal insufficiency undergoing coronary angiography （ CAG ） or precutaneous coronary intervention （PCI）. Methods： Four hundred and sixty-one inpatients with renal insufficiency in our hospital from March 1, 2003 to September 1, 2007 were divided into two groups： the isosmolar contrast media group （131 cases） and the low-osmolar contrast media group （330 cases）. All the patients underwent CAG or PCI. The serum creatinine levels on the day before CAG or PCI and on day 1,3, and 7 after CAG or PCI were measured. And the adverse reactions in the two groups were observed. Results： On the dayl, 3, and 7 after CAG or PCI, incidence of nephropathy was 6.9% , 19.1% , and 19.8% in the isosmolar contrast media group, and 23.9% , 36.4% , and 39.4% in the low-osmolar contrast media group, respectively. The deferences between the two groups were statistically significant （ all P 〈 0.05 ）. On the day 1 and 3 after CAG or PCI, the increased serum creatinine levels were （ -15.8 ± 55.5 ） μmol/L and （ 12. 3 ± 58.0 ） μmol/L in the isosmolar contrast media group, and （ 20.1 ± 53.7 ） μmol/L and （ 38.3 ± 62.4 ） μmol/L in the lowosmolar contrast media group, respectively. The deferences between the two groups were statistically significant （ all P 〈 0.05 ）. Conclusion： Isosmolar contrast media is less nephrotoxic than low-osmolar contrast media used in the patients with renal insufficiency. And it is safer for the patient with renal insufficiency undergoing CAG or PCI.