非离子型造影剂所致造影剂肾病的临床分析

Clinical Analysis of Contrast-Nonionic Induced Nephropathy

目的探讨冠状动脉介入治疗患者造影剂肾病危险因素。方法收集2005年5月—2008年11月在我院住院的360例接受冠状动脉介入治疗患者的临床资料,分为有合并症组和无合并症组,有合并症组又分为高血压组、糖尿病组和高血压合并糖尿病组,回顾性分析患者的血肌酐水平变化及造影剂肾病发生的情况。结果360例患者中,有合并症组发生造影剂肾病16例,而无合并症组无一例发生造影剂肾病。造影后有合并症组血肌酐水平与无合并症组比较差异有统计学意义(P<0.05)。糖尿病合并高血压组造影剂肾病发生率高于糖尿病组和高血压组,差异均有统计学意义(P<0.05);而糖尿病组造影剂肾病发生率与高血压组比较差异无统计学意义(P>0.05)。结论心内科行冠状动脉介入治疗的患者常合并糖尿病和高血压,尽管选用非离子型低渗造影剂,临床上仍要高度重视造影剂肾病的发生,早期给予积极而有效的预防措施是十分必要的,应密切监测造影前和造影后24～72h的肾功能。

Objective To investigate the risk factors of contrast-nonionic induced nephropathy （CIN） in patients underwent percutaneous coronary intervention （PCI）. Methods The data of three hundred and sixteen patients admitted from April 2005 to October 2008 to our hospital were collected. These patients were divided as complication group and non complication group and the complication group was further divided as diabetes group, hypertension group and diabetes- hypertension group. The incidence of CIN and the change of serum creatinine were retrospectively analyzed. Results Among 360 patients, 16 CIN cases were found in the complication group, but no CIN case was found in the non-complication group. The serum creatinine level in the complication group was higher than that in the non-complication group （P〈0.05）. The incidence of CIN in the diabetes-hypertension group was obviously higher than those in both diabetes and hypertension groups （P〈0.05）, however no significant difference was found between the diabetes group and hypertension group （P〉0.05）. Conclusion The patient undergoing PCI in cardiology department is often complicated by diabetes and hypertension. The active and effective measures should be early given for prevention of CIN, and the renal function needs to be monitored before and 24-72 hours after coronary angiography.