半剂量荧光素钠造影剂对轻中度慢性肾病患者肝肾功能的影响——回顾性队列研究

Effect of half-dose fluorescein sodium contrast agent on liver and kidney functions in patients with mild to moderate chronic kidney disease:a retrospective cohort study

目的观察半剂量荧光素钠造影剂对轻中度慢性肾病(CKD 1-3期)患者肝、肾功能的影响。方法纳入2017年1月~2021年1月住院的77例肾功能正常及轻中度异常的慢性肾病患者,应用半剂量荧光素钠进行眼底荧光造影(FAG)检查。测定造影前3 d内和术后1、3、7、30±1 d的肝功能、血肌酐、血尿素氮(BUN)、尿β2微球蛋白(β2—MG)、肾小球滤过率(eGFR)等,分析造影剂对患者肾功能的影响。结果77例患者中,男性50例,女性27例,年龄53.5±9.6岁,只有1例发生造影剂肾病,发病率为1.30%。FAG前后BUN、尿β2-MG、快速微量白蛋白/肌酐差异均无统计学意义(P>0.05)。血肌酐在FAG后1、7 d均无升高,3 d升高值24.6±2.3(P<0.01),30 d升高16.0±21.7(P=0.239)。尿NAG酶、尿渗透压在FAG术后1、3、7、30 d均明显降低(P<0.01)。eGFR在术后第3天显著下降,下降值为10.23±0.62,术后第7天恢复正常。尿白蛋白定量在FAG术后1、3、7、30 d均明显降低(P<0.01)。血β2-MG在FAG术后3 d升高0.314±0.121(P<0.01),术后7 d降低0.134±0.143(P=0.391),术后30 d升高0.119±0.058(P=0.402)。造影前后的转氨酶在术后第3、7天下降(P<0.01)。结论半剂量荧光素钠对轻中度慢性肾病患者肝脏功能无明显影响,肾脏功能影响极小,可以安全的进行眼底荧光血管造影检查。

Objective To observe the effect of half-dose fluorescein sodium(FINa)contrast agent on liver and kidney functions in patients with mild to moderate(stage 1 to 3)chronic kidney disease(CKD)and the incidence of contrast-induced nephropathy(CIN).Methods Seventy-seven patients(including 50 male and 27 female patients with an mean age of 53.5±9.6 years)with CKD with normal renal function or mild to moderate abnormalities underwent fundus fluorescein angiography(FFG)examination with half-dose FINa.Liver function,blood creatinine(Scr),blood urea nitrogen(BUN),urineβ2 microglobulin(β2-MG),and glomerular filtration rate(eGFR)of the patients were measured within 3 days before intravenous injection of the contrast agent and at 1,3,7,and 30±1 days after the operation to analyze the effect of the contrast agent on renal function.Results Among the 77 patients,CIN occurred only in one case with an incidence rate of 1.30%.BUN,urineβ2-MG,or rapid microalbumin/creatinine did not vary significantly after FFA in these patients.Scr levels showed no significant increments at 1 day and 7 days after FFA,but increased significantly at 3 days(24.6±2.3;P<0.01)and 30 days(16.0±21.7;P<0.05).Urine NAG enzymes and urinary osmolality were significantly reduced at 1,3,7,and 30 days after FFA(P<0.01).The eGFR decreased significantly to 10.23±0.62 at 3 days after FAG and became normal at 7 days.Urine albumin level decreased significantly at 1,3,7,and 30 days after FFA(P<0.01).Bloodβ2-MGFAG level increased significantly at 3 days after FFA(0.314±0.121;P<0.01),but decreased to 0.134±0.143 at 7 days(P<0.05).The level transaminase decreased significantly at 3 and 7 days after FFA(P<0.01).Conclusion Half-dose of FINa has no significant effect on liver function and has only minimal effect on kidney function in patients with mild to moderate CKD,and FFA with half-dose FINa can therefore be safely performed in these patients.