肢体缺血后处理对造影剂肾病作用的研究

Limb ischemic preconditioning for prevention of contrast medium induced nephropathy

目的探讨远端肢体缺血后处理（LI—postC）对造影剂诱导急性。肾损伤的作用。方法随机选取将行冠脉造影且存在肾功能不全的患者（血清肌酐〉1．4mg／dl或肾小球滤过率〈60ml·min。-1．73m-2），以1：1随机分配到标准化干预组（即LI—postC组40例，造影后立即进行间歇性手臂缺血4个循环，血压袖带膨胀5min后放松5min为1个循环）和非缺血处理组（即对照组40例）。分别测定两组造影前及造影结束后6h、24h、48h的血清肌酐、胱抑素c、尿中性粒细胞明胶酶。结果发生造影剂肾病的患者共20例（占总试验人数的25％），其中对照组20例（占对照组的40％）、LI—postC组4例（占干预组的10％）（OR=0．21，P=0．002）。21例发生心血管复合终点，对照组14例（35％）、LI—postC组7例（18％）（P=-O．018）。LI—postC组患者的再入院显著低于对照组[6例（15％）比15例（38％），P=O．016]。所有远端肢体缺血后处理未产生明显不良反应。结论肢体缺血后处理对造影剂诱导急性肾损伤的高风险人群有保护作用。

Objective The aim of this study was to investigate the effect of the distal limb ischemia on the acute renal injury induced by the contrast medium in the patients with acute renal injury by using a prospective controlled trial. Methods Randomly selected patients undergoing coronary angiography with renal function injury （serum creatinine〉 1.4 mg/dl or eGFR〈60 ml·min-1 1.73m-2） and randomly assigned 1：1 to standardization in the intervention group（40 cases, intermittent arm ischemia through 4 cycles of 5-minute inflation and 5-minute defla- tion of a blood pressure cuff） or non ischemic preconditioning group （40 cases）. Serum creatinine, Cystatin C, neutral urinary neutrophil gelatinase were measured in the two groups before radiography and angiography after 6 hours, 24 hours, 48 hours. Results A total of 20 patients got acute renal injury （25%）, 16 in the control group （40% in the control group）, 4 in the limb ischemia group （10%）（0R=0.21, P=0.002）. 21 cases occurred com- posite cardiovascular end points, 14 in the control group （35%）, 7 cases in LI-postC group （18%）（P=0.018）. Compared with the control group, the re-hospitalization rate in LI-postC group was significantly lower [6 patients in LI-postC group （15%）, and 15 patients in control group （38%）, P=0.016]. No significant adverse reactions were produced in all distal limb ischemia preconditioning. Conclusion Limb ischemia postproeessing has protec- tive effect on the high risk population of acute renal injury induced by contrast agent.