碘佛醇对脑血管介入诊疗患者早期肾功能的影响

Effect of the ioversol on early renal function in patients undergoing cerebral vascular intervention

目的观察不同剂量碘佛醇对多种肾功能指标的影响，探讨造影剂肾损伤的早期指标及碘佛醇的安全用量。方法选取本科脑血管介λ（CVI）诊疗的158例患者为研究对象，其中男98例，女60例，年龄23～81（59．70±12．02）岁。根据碘佛醇用量，将患者分为低剂量组（≤150m1）49例、中剂量组（151—200m1）74例及高剂量组（〉200m1）35例。分别用散射比浊法、免疫比浊法及全自动生化分析法检测术前24h和术后72h内U—K、U-λ、尿转铁蛋白（UTRF）、尿微量白蛋白（UMA）、尿免疫球蛋白IgG（UIgG）、尿β2-微球蛋白（uB2-MG）、Uα1-MG、尿N-乙酰β-D-氨基糖苷酶（UNAG）及胱抑素c（CysC）、Scr的水平；根据术后72h内Scr绝对值升高≥44．2μmol／L或较基础值升高≥25％，计算碘佛醇造成的急性肾损伤（CI—AKI）的发生率；用单因素及多因素二项Logistic回归，分析各种影响因素及不同剂量碘佛醇对上述指标水平的影响。结果158例患者中，依据术后Scr升高绝对值≥44．2μmol／L计算，3例发生CI—AKI，发生率为1．90％；依据术后Scr升高相对百分比t〉25％计算，33例发生CI—AKI，发生率为20．89％。与低剂量组比较，碘佛醇高剂量组术后U—K、UTRF、UTRF-MG、UNAG及CysC水平明显更高，差异有统计学意义（均P〈0．05），而U-λ、UIgG、U[52-MG、UMA两组术后比较差异无统计学意义（P〉0．05）。结论动脉注射造影剂碘佛醇可引起CI—AKI；一次性应用碘佛醇200ml以上，可引起脑血管介λ患者术后u—K、UTRF、UTRF、Uα、UNAG及CysC急性肾损伤的早期指标发生改变；且其改变与造影剂用量有关。

Objective To investigate the effect of different doses of ioversol on renal function, and to explore early renal injury biomarkers on contrast induced kidney injury and safe ioversol dosage. Meth- ods A total of 158 cases （98 males and 60 females） undergoing cerebral vascular intervention （CVI） in our department was selected with age ranging from 23 to 81 years old （average age 59. 70±12. 02）. Based on ioversol dosage in surgery, patients were divided into three groups： low dose group （≤150 ml,n =49） , middle dose group （151 -200 ml,n =74）, and high dose group （ 〉200 ml, n =35）. U-κ, U-λ, urinary transferrin （UTRF） , urine microalbumin （UMA） , urinary immunoglobulin IgG （UIgG） , urine beta2-microglobulin （Uβ2-MG） , UCtl-MG, urinary N-acetyl-beta-D-glueosaminidase （UNAG） , plasma eystatin C （CysC） and Scr were detected by scattering turbidimetry, immune turbidimetry and fully automatic bio-chemical analysis pre-surgery 24 h and post-surgery 72 h. Contrast-induced acute kidney injury （CI-AKI） was defined as laboratory increase of Scr value≥44. 2μmol/L or ≥25% from baseline measurement at 48 hours after surgery. The relationship in ioversol dosage and various factors was assessed by Single and multi- ple factors binary logistic regression analysis. Results According to the criterion that Scr increase value were≥44. 2μmoL/L, of 158 cases, 3 cases occurred CI-AKI, the AKI incidence was 1.90%. Based on the criterion that Scr increase value was 325% , 33 cases occurred CI-AKI, the incidence was 20. 89%. The concentration of U-κ, UTRF, Uα1-MG, UNAG and plasma CysC were significantly different in high dose group compared to low ioversol dose group （ P 〈 0.05 ） , while the other biomarkers had no significant difference （P 〉 0. 05 ）. Conclusions The contrast media-ioversol could lead to CI-AKI ; when the dosage of ioversol was more than 200 ml one-time, the concentration of U-κ, UTRF, Uα1-MG, UNAG and plasma CysC increased significantly. U-κ, UTRF, Uα1-MG, UNAG and plasma CysC could predict the early renal injury in patients who undergoing CVI. The rise of U-κ, UTRF, Uα1 -MG, UNAG and plasma CysC are related to the dosage of ioversol. Furthermore, possibility of kidney injury is significantly high when ioversol dosage is more than 200 ml one-time.