低渗非离子型对比剂使用及不同给药途径对尿微量白蛋白增高患者肾功能的影响

Influence of use of hypotonic non-ionic contrast agent and different administration on renal function of patient with increased UMA

目的探讨尿微量白蛋白（UMA）增高患者使用低渗非离子型对比剂的安全性,并评价对比剂的不同给药途径对UMA增高患者肾功能的影响。方法选择2012年8月—2014年8月在本院因疾病诊治需要接受冠状动脉介入诊疗术或冠状动脉增强CT检查的患者为研究对象,所有患者均使用低渗非离子型对比剂（碘佛醇）,对比剂使用前检测UMA。尿白蛋白20~200 mg/L者根据对比剂给药途径不同分为介入组（70例）及CT组（30例）。将同期行冠状动脉介入诊疗术且尿白蛋白〈20mg/L者设立为对照1组（70例）;根据对比剂使用剂量在介入组患者中二次筛选,设立对照2组（27例）。探讨介入组和对照1组患者对比剂肾病（CIN）发病率与UMA的关系,评价CT组和对照2组患者对比剂使用后对肾功能的影响。结果介入组与对照1组相比更易发生CIN（17%vs 7.1%）,差异有统计学意义（P〈0.05）。CT组与对照2组相比较,CIN发生率无差异。结论UMA可作为评估CIN发生的危险因素,其增高增加了CIN发生的风险。定量对比剂使用前提下,CIN发生与对比剂给药途径无明显相关。

Objective To explore the safety of the use of the hypotonic non-ionic contrast agent in treatment of patients with increased microalbuminuria（ UMA） and to assess the influence of different administration routes on renal function. Methods Patients in need of coronary artery interventional treatment or coronary artery enhanced CT examination in our hospital from August 2012 to August 2014 were selected. All of them were treated with hypotonic non-ionic contrast agent（ ioversol）.Before the use of contrast agent,the patient＇s UMA was examined. Patients with the urinary albumin20 ~ 200 mg / L were divided into the intervention group（ n = 70） and CT group（ n = 30） according to different agent administration routes. Patients underwent coronary interventional treatment with the urinary albumin 20 mg / L were designed as control group 1（ n = 70）. According to the secondary screening of the contrast agent dose in the intervention group,control group 2（ n = 27） was designed.Relationship between the incidence of contrast-induced nephropathy（ CIN） and UMA of patients in the intervention group and control group 1 were analyzed,and the influence of contrast agent on renal function in the CT group and the control group 2 were evaluated. Results Compared with control group 1,the intervention group had a higher incidence rate of CIN（ 17% vs 7. 1%,P 0. 05）. There was no significant difference of CIN incident between CT group and control group 2. Conclusion UMA can be used as a risk factor of CIN,and its rise indicate the increasing of the risk. Under the premise of quantitative contrast agent,incidence of CIN had no significant correlation with the administration route.