静脉注射碘克沙醇(270mgI/ml)肾脏不良反应的临床观察

Renal adverse effect of intravenous administration of iodixanol(270mg I/ml)

目的:探讨静脉注射碘克沙醇(270mg I/ml)对肾功能的影响。方法:回顾性分析行冠状动脉CTA检查的432例连续患者的病例资料,根据对比剂的使用情况将研究对象分为:等渗对比剂组,注射碘克沙醇(270mg I/ml),115例;低渗对比剂组,注射碘帕醇(370mg I/ml),317例。搜集同期住院患者中行平扫CT的110例连续患者资料作为对照组。比较3组患者的临床特点,检查前后血清肌酐(Scr)和估计肾小球滤过率(eGFR)的变化,以及对比剂肾病(CIN)的发病率。结果:432例患者均未发生严重的急性不良反应。三组年龄差异有统计学意义(P<0.05):其中等渗对比剂组平均年龄较低渗对比剂组及对照组大(P<0.017)。三组的性别构成比差异无统计学意义(P>0.05)。三组间CIN危险因素的差异有统计学意义(P<0.05):其中等渗对比剂组有危险因素的患者比例较低渗对比剂组及对照组多(P<0.017);低渗对比剂组有危险因素的患者比例较对照组多(P<0.017)。CT检查后各组Scr和eGFR的变化(与检查前基线值比较):等渗对比剂组Scr下降,eGFR升高(P<0.05);低渗对比剂组检查后Scr升高(P<0.05);对照组Scr及eGFR的变化均无统计学意义。等渗对比剂组、低渗对比剂组CIN发病率分别为2.6%、7.9%。13.6%的平扫患者出现了符合CIN诊断标准的Scr升高。等渗对比剂组CIN的发病率明显低于对照组(P<0.017)。等渗对比剂组与低渗对比剂组、低渗对比剂组与对照组CIN发病率差异均无统计学意义。结论:静脉注射等渗对比剂碘克沙醇(270mg I/ml)对肾功能没有影响,静脉注射低渗对比剂碘帕醇(370mg I/ml)后Scr升高,两组的CIN发病率接近。不注射碘对比剂的CT检查患者,在检查后也可能由于其他因素导致肾功能降低,其"CIN"的发病率比注射等渗对比剂组高,与低渗对比剂组接近,因此判断CIN时应除外其他影响因素,避免对CIN的过度诊断。

Objective：To study the adverse effects of iodixanol on renal function of patients. Methods：Totally 432 in patients undergone coronary CTA examination were retrospectively analyzed. The patients were divided into two groups： iso-osmolar contrast media group （IO group）, 115 cases, using iodixanol （270mg I/ml）, and low-osmol.ar contrast media group （LO group）, 317 cases, using iopamidol （370mg I/ml）. One hundred and ten in-patients undergone unenhanced CT were recruited as control group. The clinical features, changes of plasma Scr and eGFR （estimated glomerular filtration rate） ,incidence of CIN （contrast-induced nephropathy） were compared and analyzed. Results： No serious acute adverse events were recorded. The average age of IO group was much smaller than that of LO group and control group （P〈0. 017）. No statistically difference was found in sex constituent ratio between these three groups. There were more patients with risk factors in IO group than in the other two groups （P〉0. 017） ,and more patients with risk factors in LO group than in con trol group （P〈0. 017）. The plasma Scr deceased and eGFR increased in IO group （P〈0.05）. The plasma Scr increased in LO group （P〈0. 05）. The plasma Scr and eGFR showed no statistically significant difference before and after unenhanced examination. Incidence of CIN：the incidence of CIN in IO group and LO group was 2.6%and 7.9 %, respectively. 13.6 % of patients in control group met the definition of CIN with increased Scr after unenhanced CT examination. The incidence of CIN in IO group is much lower than that of control group （P^0. 017）. There was no statistically significant difference in incidence of CIN between IO group and LO group,as well as between LO group and control group. Conclusion：There is no adverse effect on renal function in IO group, while there is increase of Scr in LO group. The incidence of CIN in IO group is close to that in LO group. The increase of Scr could be observed in patients without contrast media administration, so the judgment of ＂CIN＂ should be cautious, with careful discrimination of other factors of renal function impairment.