冠状动脉病变与造影剂肾病的相关性研究

The relationship of relationship between coronary artery disease and contrast-induced nephropathy

目的 观察冠状动脉病变患者使用造影剂后发生造影剂肾病（CIN）的情况.方法 对268例进行冠状动脉造影检查的患者,根据造影结果分为冠状动脉正常组和冠状动脉病变组,又根据冠状动脉病变程度将冠状动脉病变组分为单支病变、双支病变、多支病变或左主干病变.再根据造影剂的用量不同将268例患者分为低剂量组、中剂量组和高剂量组,测定术后血清肌酐（SCr）水平,将冠状动脉病变程度、造影剂的用量与血清肌酐水平进行相关性分析.结果 冠状动脉正常组血清肌酐造影前后无明显变化,未发生CIN.而冠状动脉病变组造影后血清肌酐有明显升高,CIN发病率为14.5%,与造影前差异有统计学意义（P＜0.05）,且血肌酐恢复较慢,造影后第4天仍处于较高水平,与造影前差异有统计学意义（P＜0.05）.造影剂的用量与血清肌酐上升水平及CIN发病率有着显著的相关性,高剂量的造影剂更易引发CIN.结论 冠状动脉病变越严重,越容易引发CIN,操作时应当严格控制造影剂用量.

Objective To investigate the clinical character istics of contrast-induced nephropathy（CIN）in patients with coronary artery disease after they used contrast media.Methods 268 patients used contrast media were divided into normal coronary artery group and pathological coronary artery group according to the results of angiography.And the pathological coronary artery group were divided into lesion with single-vessel group,lesion with doublevessel group and lesion with multi-vessel（or left main vessel lesion）group.The 268 patients also were divided into 3 groups according to the dose of contrast media,low dose group,middle dose group and high dose group.Analyse the relativity of grade of coronary artery disease,dose of contrast media and level of serunl ereatinine（Scr）after determination the level of Scr.Results Scr didn＇t increase after received contrast media in normal coronary artery group,while increased in the pathological COronary artery group and the increase Was remarkable（P〈0.05）.The morbidity of CIN in the pathological coronary artery group was up to 14.5%with statistical significance（P〈0.05）from 0%in the normal group.And the recovery of Scr was slow in pathological coronary artery group.The level of Scr was still high with statistical significance in the forth day after angiography（P〈0.05）.The dosages of contrast media significandy affected on the Scr and the rate of CIN.The higher dose of contrast media,the higher rate of CIN.Conclusion The CIN could be caused in patients with coronary artery disease,the dosages of contrast media should be controlled strictly.