短时间内经不同途径重复应用对比剂对患者肾功能的影响

The impact of repeated application of contrast media on renal function within a short period of time in different occasions

目的探讨冠状动脉增强CT检查后1周内再次行冠状动脉造影（CAG）或经皮冠状动脉介入治疗（PCI）对患者肾功能的影响。方法选择就诊于保定市第一中心医院已行冠状动脉增强CT将进一步行CAG或PCI的患者258例,随机分为试验组132例和对照组126例,试验组为行冠状动脉增强CT检查后1周内再次行CAG或PCI,对照组的时间间隔为1～2周。监测两组患者术前和术后1、2、3 d血肌酸酐、胱抑素C水平,计算估算的肾小球滤过率（e GFR）,并记录对比剂肾病（CIN）的发生率。结果两组患者的一般资料比较,差异均无统计学意义（均P〉0.05）。两组患者间术前和术后1、2、3 d各时间点的血肌酸酐、胱抑素C、e GFR水平分别比较,差异均无统计学意义（均P〉0.05）。试验组发生CIN 7例（5.3%）,对照组发生CIN 6例（4.8%）,两组比较,差异无统计学意义（P=0.843）。结论对于e GFR≥60 ml/（min·1.73 m2）的患者静脉应用对比剂行冠状动脉增强CT检查后1周内再次行CAG或PCI是安全可行的。

Objective To discuss the impact of repeated contrast media exposure on renal function in patients who received coronary angiography（ CAG） or percutaneous coronary intervention（ PCI） within 1week after CTA of coronary ateries. Methods A total of 258 patients who received CAG or PCI after coronary CTA were divided into the study group（ n = 132,patients had CAG / PCI within 1 week after CTA）and the control group（ n = 126,patients had CAG / PCI 1- 2 weeks after CTA）. Serum creatinine,cystatin C and estimated GFR were tested before and on day 1,2 and 3 after procedures. The occurance of contrastinduced nephropathy（ CIN） was recorded. Results The baseline clinical characteristics of the patients between the two groups had no significant difference. Preoperative and postoperative serum creatinine,cystatin C and e GFR values on day 1,2 and 3 had no significant difference between the two groups（ all P〉0. 05）. There was no significant difference in the incidence of CIN between two groups（ 5. 3% in the study group vs. 4. 8% in the control group,P〉0. 05）. Conclusions It is safe and feasible for patients with e GFR≥60 ml /（ min·1. 73 m2） to undergo CAG or PCI within 1 week after coronary CTA.