应用尿微量蛋白系列对比等渗造影剂与次高渗造影剂对肾损伤的临床研究

Comparison in effects of isoosmotic contrast agent and low-osmotic contrast agent on renal damage by using urinary microprotein series:a clinical study

目的应用尿微量蛋白系列对比等渗造影剂与次高渗造影剂对肾脏的损伤。方法采用前瞻性研究方法收集100例拟在我院行冠状动脉(冠脉)PCI手术的患者,并将其随机分为等渗造影剂组(碘克沙醇组,n=50)和次高渗造影剂组(碘普罗胺组,n=50),术前及术后检测患者血肌酐、尿微量蛋白系列水平,比较碘克沙醇组与碘普罗胺组造影剂肾病的发生率及尿微量蛋白系列的变化。结果①碘克沙醇组与碘普罗胺组比较,造影剂肾病发病率无统计学意义(P>0.05)。②尿微量蛋白系列两组间比较显示:肾小球性蛋白尿(包括选择性蛋白尿、非选择性蛋白尿)发生率无统计学意义(P>0.05);而碘克沙醇组肾小管性蛋白尿及混合性蛋白尿(肾小球性蛋白尿+肾小管性蛋白尿)发生率显著低于碘普罗胺组(P<0.05)。结论与次高渗造影剂相比较,等渗造影剂具有减少肾小管性蛋白尿及混合性蛋白尿的益处。

Objective To compare the renal damage induced by isoosmotic contrast agent and low-osmotic contrast agent by using urinary microprotein series.Methods The patients(n=100)undergoing PCI were chosen from the Fourth Affiliated Hospital of Harbin Medical University by using prospective study method,and all patients were randomly divided into isoosmotic contrast agent group(iodixanol group)and low-osmotic contrast agent group(iopromide group,each n=50).The levels of serum creatinine(SCr)and urinary microprotein series were detected in all groups before and after the operation.The incidence rate of contrast-induced nephropathy(CIN)and changes of urinary microprotein series were compared between 2 groups.Results①The comparison in CIN incidence rate showed that there was no statistical significance between 2 groups(P>0.05).②The comparison in urinary microprotein series showed that there was no statistical significance in incidence rate of glomerular proteinuria(including selective proteinuria and non-selective proteinuria)between 2 groups(P>0.05).The incidence rates of tubular proteinuria and mixed albuminuria(glomerular proteinuria+tubular proteinuria)were significantly lower in iodixanol group than those in iopromide group(P<0.05).Conclusion Compared with low-osmotic contrast agent,isoosmotic contrast agent can reduce the incidence rates of tubular proteinuria and mixed albuminuria.