摘要
目的观察等渗非离子型对比剂碘克沙醇对接受冠状动脉介入治疗(PCI)患者近期及远期肾功能的影响,探讨迟发型(>1个月)对比剂肾病(delayed contrast induced nephropatholgy,DCIN)的诱因及危害。方法观察2007年6月至2011年6月242例采用碘克沙醇行PCI治疗患者,根据PCI前24 h、PCI后2～3 d、1个月和3个月的血清肌酐水平,将患者分为对比剂肾病(CIN)组、DCIN组和肾功能无恶化组,评价多种危险因素与DCIN的相关性。结果与PCI术后肾功能无恶化组(5.02±1.64)相比,DCIN组和CIN组Mehran危险积分显著升高(分别为6.72±2.48和6.97±2.51),组间差异有统计学意义(P<0.001);DCIN组和CIN组中,糖尿病、慢性肾功能不全、心功能不全等疾病伴发率显著增高(P<0.05);临床心血管事件率和全因死亡率显著增高(P<0.05),但上述因素在CIN组和DCIN组间差异无统计学意义(P>0.05)。结论在PCI术前应用Mehran危险积分可以充分评估CIN风险。即使具有很好的肾脏耐受性,等渗对比剂同样需要注意术中用量。PCI术后长期监测患者肾功能与治疗前充分评估CIN风险同样重要。
Objective To observe the short-term and long-term effect of Iodixanol, an isotonic and non- ionic contrast media, on the renal function in patients undergoing percutaneous coronary intervention （PCI）, and to discuss the predispositions and damage of delayed contrast-induced nephropathy. Methods A total of 242 patients, who were admitted to the hospital and received PCI by using Iodixanol during the period from Jun. 2007 to Jun. 2011, were enrolled in this study. Based on the serum creatinine levels （an increase by 25% or 44 umol/L after PCI） determined at 24 hours before PCI, and 2 - 3 days, one and three months after PCI, the patients were classified into contrast-induced nephropathy （CIN） group, delayed contrast- induced nephropathy（DCIN） group and no renal function deterioration（NRFD） group. The correlation between various risk factors and the DCIN was evaluated. Results Mehran risk scores of NRFD group, DCIN group and CIN group were （5.02 ± 1.64）, （6.72 ±2.48） and （6.97 ± 2.51） respectively. The differences in Mehran risk scores between NRFD group and DCIN group, between NRFD group and CIN group were statistically significant （P 〈 0.001）. In DCIN group and CIN group, the incidence of coexisting diabetes, chronic renal insufficiency and chronic cardiac function insufficiency was significantly higher （P 〈 0.05）, moreover, the clinical incidence of cardiovascular event and mortality were also significantly higher （P 〈 0.05） although the differences in these two items between DCIN group and CIN group were not significant （P 〉 0.05）.Conclusion Mehran risk score estimated before PCI can be used to evaluate the CIN risk. Although the isotonic and non- ionic contrast media can be well tolerated by the kidney, the amount of Iodixanol used in PC! should be controlled. Long-term careful observation for the occurrence of CIN after PCI is as important as the evaluation of CIN risk made before PCI.（J Intervent Radiol, 2013, 22： 015-019）
出处
《介入放射学杂志》
CSCD
北大核心
2013年第1期15-19,共5页
Journal of Interventional Radiology
基金
上海交通大学“医工交叉研究基金”重点项目(YG2011ZD02)
关键词
冠心病
介入治疗
肾功能不全
碘克沙醇
percutaneous coronary disease
intervention
renal insufficiency
Iodixanol
作者简介
通信作者：陆志刚E-mail：zhigang．1u@medmail．com．cn
