等渗造影剂对慢性充血性心力衰竭患者介入治疗后肾功能的影响

Influence of iso-osmolar contrast media on renal function in patients with chronic heart failure ;undergoing coronary interventional therapy

目的：观察等渗与低渗造影剂对慢性充血性心力衰竭患者行介入治疗后肾功能的影响。方法选择2015年1月至2016年5月接受冠状动脉造影（CAG）或冠状动脉介入治疗（PCI）的慢性充血性心力衰竭患者220例，按随机数字表法分为等渗组第3天测定血清肌酐（SCr）、肾小球滤过率、胱抑素C（CysC）水平，观察两组术后造影剂肾病（CIN）的发生率。结果两组术前SCr、肾小球滤过率、CysC水平比110例，低渗组110例，等渗组应用等渗造影剂碘克沙醇，低渗组应用低渗造影剂碘海醇，两组患者分别于术前1天、术后第1天和较差异无统计学意义（P＞0.05）。术后第1天两组患者的SCr水平均升高，但组间比较差异无统计学意义（P＞0.05），而术后第1天等渗组肾小球滤过率高于低渗组、CysC水平低于低渗组，差异有统计学意义（P＜0.05）。术后第3天，等渗组肾小球滤过率仍高于低渗组、CysC水平也仍低于低渗组，差异有统计学意义（P＜0.01）。两组共发生CIN 46例，总的CIN发生率为20.9％（46/220）。其中低渗组发生CIN 32例，CIN发生率为29.1％（32/110），等渗组发生CIN 14例，CIN发生率为12.7％（14/110），两组CIN发生率比较差异有统计学意义（P＜0.05）。结论在慢性充血性心力衰竭患者进行介入治疗时，等渗性造影剂比低渗性造影剂具有更低的CIN发生率。

Objective To compare iso-osmolar iodixanol and low-osmolar iohexol for the incidence of contrast- induced nephropathy（CIN） in patients with chronic congestive heart failure undergoing coronary interventional therapy. Methods The study included 220 consecutive patients with chronic congestive heart failure and undergoing coronary angiography （CAG） with or without percutaneous coronary intervention （PCI） bewteen Janurary 2015 and May 2016. Study participants were divided into two groups by random digits table：iso-osmolar group （110 patients） and low-osmolar group （110 patients）. The patients in iso-osmolar group were given iodixanol, and the patients in low-osmolar group were given iohexol. Serum creatinine （SCr）, glomerular filtration rate （GFR） and cystatin C （CysC） were detected before the procedure and on the first, third day after the procedure. Then, the incidence of contrast-induced nephropathy （CIN） in two groups within 72 h of the procedure were observed and compared. Results The levels of SCr, GFR, CysC before operation had no significant differences （P〉0.05）. The levels of SCr in two groups on the first day after operation were increased, but there was no significant difference between two groups （P〉0.05）. On the first day after operation, the level of GFR in iso-osmolar group was higher than that in low-osmolar group, the level of CysC in iso-osmolar group was lower than that in low-osmolar group, and there were significant differences （P〈0.05）. On the third daynbsp;after operation, the level of GFR in iso-osmolar group was higher than that in low-osmolar group, the level of CysC in iso-osmolar group was lower than that in low-osmolar group, and there were significant differences （P〈0.01）. The overall incidence of CIN was 20.9%（46/220）. The incidence of CIN in low-osmolar group was 29.1%（32/110）, in iso-osmolar group was 12.7%（14/110）, and there was significant difference （P〈0.05）. Conclusions In chronic congestive heart failure patients undergoing coronary interventional therapy, the iso-osmolar contrast iodixanol is associated with a lower incidence of CIN compared with low-osmolar iohexol.