摘要
目的探讨肾功能不全患者发生造影剂肾病(CIN)的危险因素、临床特点及预后。方法回顾分析北京协和医院住院诊断肾功能不全并接受冠状动脉造影的患者44例,其中造影后发生CIN23例,未发生CIN21例,比较两组患者的临床特点、造影日用药情况、造影剂使用剂量、造影前后的肾功能变化;根据造影后2周内血肌酐(Scr)水平是否下降至造影前水平,将发生CIN患者分为肾功能恢复组(12例)和肾功能未恢复组(11例),比较两组患者临床特点、造影日用药情况、造影前肾功能、造影剂使用剂量、造影日出入量。结果所有肾功能不全患者的CIN发生率为52.3%(23/44),其中Scr在132.6～168μm ol/L患者的CIN发生率为42%(8/19),Scr>176.8μm ol/L的患者CIN发生率为60%(15/25);在23例CIN患者中,造影剂用量平均(144.79±71.8)m l,其中用量超过造影剂安全使用剂量的占43.5%(10/23)危险因素评分为5.14±1.3,与未发生CIN组相比差异具有显著性(P<,0.05)。多元逐步回归分析显示,使用造影剂的剂量与CIN的发生呈正相关(F=10.4,P=0.003)。发生CIN患者造影后24、48、72h的Scr、肌酐清除率(Ccr)与造影前相比差异具有显著性(P<0.05),而造影前后尿量无明显变化。发生CIN患者12例(52.2%)造影后2周内Scr下降至造影前水平,11例(47.8%)肾功能未恢复。
Objective To investigate the risk factors, clinical characteristics, and prognosis of con-trast-induced nephropathy(CIN)in patients with renal dysfunction. Methods We retrospectively analyzed 44 patients with renal dysfunction who received coronary angiography in our hospital. CIN was found in 23 patients, after angiography. We compared the clinical characteristics, medication during angiography day, volume of contrast-medium, as well as renal function changes before and after angiography in patients with(23 cases)and without(21 cases)CIN. The CIN patients were further divided into two groups according to their serum creatinine(Scr)levels: renal function recovery group(12 cases)and renal function non-recovery group(11 cases), and difference between these two groups was analyzed.Results CIN incidence was 52.3%(23/44)in all 44 patients with renal dysfunction. CIN incidence was 42%(8/19)in patients whose Scr was between 132.6 - 168 μmol/L, was 60%(15/25)in those whose Scr was more than 176.8 μmol/L. In all 23 CIN patients, the average volume of contrast-medium was(144.79 ± 71.8)ml, while 43.5% of the CIN patients whose dosage was over the maximum threshold of contrast-medium; the average risk factors were 5.14±1.3. Compared with the group without CIN, the difference was statistically significant(P < 0.05). Multiple stepwise regression analysis showed the volume of radio-contrast-medium was correlated with CIN in patients with renal dysfunction(F=10.4, P = 0.003). Patients in the CIN group showed a significant rise of Scr level 24, 48, and 72 hours after angiography. However, the urine volume had no change before and after angiography. Renal function was improved in 12 of 23 patients(52.2%), and deteriorated in 11 patients(47.8%). Four patients(17.4%)received dialysis. Compared with the non-reavery group, Scr levels(194.5 ± 70.7)μmol/L,(443.8 ± 282.9)μmol/L, respectivelyof pre-angiography in renal function recovery group and the patients whose dosage was over maximum threshold of contrast-medium(2/12, 8/11)had signifi-cant difference(P < 0.05). Conclusions Higher volume of contrast-medium is a risk factor of CIN in patients with renal dysfunction. Pre-angiography Scr level and the contrast-medium volume are correlated with the prognosis of CIN in such patients.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2005年第2期232-236,共5页
Acta Academiae Medicinae Sinicae
关键词
肾功能不全
造影剂肾病
危险因素
造影剂的剂量
造影剂安全使用剂量
renal dysfunction
contrast-induced nephropathy
risk factor
volume of contrast-medium
maximum contrast- medium volume
