国内关于非离子造影剂对肾功能损害影响的评价

Evaluation for the influence of nonionic contrast media on renal function damage

非离子造影剂在现代影像诊断和介入治疗中的应用日益增多,造影剂所致的急性肾损害也明显增加。文中收集一些国内资料,针对非离子造影剂用于增强CT和用于冠脉造影或相关手术如冠状动脉介入术（PC I）和经皮腔内冠状动脉成形术（PTCA）,在肾功能正常的高危人群或肾功能轻度损害患者中,使用了非离子造影剂对肾功能损害影响的评价。指出高危人群,特别是合并糖尿病、高尿酸患者,应警惕出现造影剂所致肾病。对于肾功能轻度损害患者,造影剂有一过性肾损害,但7-10 d可恢复。此外,对不同剂量造影剂对肾功能影响的研究,证明造影剂的肾损害可能有一定的临界值,只要造影剂的剂量不超过294 mL,一般不会造成肾功能损害。最后对造影剂可能产生的肾功能损害提出预防与应对措施。

With increasing applications of the nonionic contrast media in the modern imaging diagnosis and interventional therapy,the acute renal damage caused by contrast media also increases evidently.In this paper,the related data of the nonionic contrast media in China were collected.These nonionic contrast media have been used to enhance CT and coronary imaging or related operations,such as PCI and PTCA.The influence of the nonionic contrast media was evaluated in high risky populations with the normal renal function or with mild renal dysfunction.The author points out that high risky population,especially the patients with diabetes and high uric acid,should watch out for contrast nephropathy.In the patients with the mild renal dysfunction,the contrast media only induce transient renal damage that may return to pre-enhanced CT level or pre-operation level within 7~10 days.In addition,studies for dosages show that contrast media may have a critical point for renal function damage,i.e.if the dose is lower than 294 mL,contrast media will not induce renal function damage.At last,the preventing and responding methods were pointed out as well.