低渗与等渗对比剂对冠脉介入患者肾功能的影响

目的观察低渗及等渗对比剂对冠脉介入治疗患者肾功能的影响。方法选择2006年11月—2008年7月于我院接受冠脉介入治疗的患者398例,随机分为低渗组(A组)及等渗组(B组)。其中A组202例[男130例,女72例,平均(60.4±12.6)岁],B组196例[男118例,女78例,平均(61.2±13.5)岁];A组中术前肾功能正常者157例(77.7%A1组),肾功能异常者45例(22.3%A2组);B组中术前肾功能正常者148例(75.5%B1组),肾功能异常者48例(24.5%B2组);所有患者术前及术后72h均测定血清肌酐水平。结果A1组及B1组术后血清肌酐水平无明显变化;A2组术后血清肌酐水平明显增高(P<0.05);B2组术后血清肌酐水平有所升高,但无统计学意义(P>0.05)。结论应用等渗对比剂可降低对比剂肾病的发生率。     

非离子型双体对比剂在冠状动脉介入治疗中应用的安全性观察

目的评估非离子型双体等渗对比剂(碘克沙醇)在冠状动脉病变介入治疗(PCI)中应用的安全性。方法285例患者因心绞痛入院行PCI分为两组:非离子型双体对比剂(碘克沙醇组)120例和单体对比剂(碘帕醇组)165例。比较两组的一般情况、PCI前后肾功能变化及对比剂肾病发生率。结果PCI后24h碘克沙醇组血清肌酐升高值显著低于碘帕醇组,分别为(2.55±17.7)mmol/L和(14.39±10.6mmol/L,P<0.01),但两组的对比剂肾病发生率无显著差异,分别为11.7%和19.4%(P>0.05)。结论PCI时应用非离子型双体对比剂安全可靠,且较非离子型单体对比剂显著降低血清肌酐升高幅度,但并不能减低对比剂肾病的发生率。     

不同类型对比剂对行PCI术急性心肌梗死患者肾功能的影响

目的研究不同类型对比剂对行PCI术急性心肌梗死患者肾功能的影响。方法选取98例行PCI术的急性心肌梗死患者,其中50例使用等渗对比剂(等渗组),48例使用低渗对比剂(低渗组)。患者行PCI术后,分别于造影当天、造影后第1天、第3天、第7天测定血尿素氮(BUN),血肌酐(Scr)、以及肌酐清除率(Ccr)。同时住院期间密切关注患者的不良反应,若不良反应严重立即采取抢救措施。结果两组患者BUN、Scr、Ccr在术前术后均无显著性差异。术前以及术后等渗组和低渗组间亦无明显差异,P0.05。两组患者血清Scr水平基本上先升高,后下降;同一天测定两组的Scr水平无明显差异。但造影后第一天和第三天两组患者Scr变化水平差异显著,P0.05。此外,等渗组CIN发生率为2.0%;低渗组发生率4.3%,略高于等渗组,但二者无显著性差异,可见两种类型对比剂对CIN发生率无显著影响。另两组患者不良反应轻微,二者无显著性差异。结论等渗对比剂和低渗对比剂对行PCI术急性心肌梗死患者肾功能的影响无显著性差异。     

超敏C蛋白对冠脉造影阴性患者术后短期肾功能的影响及阿托伐他汀干预作用

目的探讨冠脉造影阴性患者术前高超敏C蛋白(hs-CRP)对术后肾功能的影响及阿托伐他汀的干预作用。材料与方法收集56例阴性患者术前、术后第1天、第2天血肌酐(Scr)、尿素氮(BUN)、尿α1-微球蛋白(α1-MG)、尿转铁蛋白(TRF)、尿微量白蛋白(mALB)及血浆胱抑素C(CysC)、hs-CRP资料,根据血肌酐计算肌酐清除率(Ccr)和CysC计算肾小球滤过率(GFR)。分组:根据术前hs-CRP水平分为hs-CRP升高组(hs-CRP≥3mg/L,n=18)和hs-CRP正常组(hs-CRP<3mg/L,n=38),根据术前是否给予阿托伐他汀分为治疗组(n=32)及对照组(n=24)。结果与术前相比,hs-CRP升高组及hs-CRP正常组术后CysC、mALB上升而GFR降低(P<0.05);与hs-CRP正常组相比,hs-CRP升高组术后CysC、mALB上升而GFR降低更为显著(P<0.05);与对照组相比较,阿托伐他汀治疗组术后第1天及第2天hs-CRP升高幅度较低,但差异无统计学意义(P>0.05)。结论对比剂对冠脉造影阴性患者具有肾损害,特别是术前hs-CRP升高患者,术前给予阿托伐他汀能减轻术后炎性反应。     

阿托伐他汀对介入手术患者对比剂应用后肾功能的影响

 目的 观察阿托伐他汀对介入手术患者对比剂应用后肾功能的影响.方法 196例脑动脉弹簧圈介入手术患者随机分为2组,阿托伐他汀组98例,术前3 d给予阿托伐他汀80 mg/d;对照组98例,术前3 d给予安慰剂.观察血清肌酐(SCr)、尿N-乙酰β氨基葡萄糖苷酶(NAG)和尿渗透浓度水平.结果 术后第2天阿托伐他汀组血清SCr显著低于对照组,尿NAG水平显著低于对照组(P＜0.05).结论 阿托伐他汀能够预防脑动脉介入手术患者对比剂应用后肾功能恶化.     

合并慢性肾功能不全患者经皮冠脉介入治疗116例

目的　回顾分析冠心病合并慢性肾功能不全患者经皮冠脉介入治疗的临床资料 ,旨在揭示其临床特点 ,对其治疗及造影剂肾病的预防进行初步探讨。方法　① 1997年 1月～ 2 0 0 1年 12月同台完成冠脉造影及PCI治疗的 116例血清肌酐 (SCr)≥ 14 1μmol/L患者作为病例组 (慢性肾功能不全组 ) ,同期进行相同介入治疗的 35 2例年龄、性别和一般情况相匹配 ,SCr <14 1μmol/L的患者作为对照组 ,记录各组临床资料 ,SCr采用苦味酸法测定 ,正常值 4 3～ 133μmol/L。②慢性肾功能不全患者在介入治疗前 3～ 7d开始施与水化疗法 :静滴葡萄糖氯化钠 5 0 0～ 10 0 0ml/d ,静注速尿 2 0～ 6 0mg/d ,同时应用血管扩张剂 :静滴多巴胺 ,2 .5～ 3.0 μg·kg- 1·min- 1,2 0～ 4 0mg/d。PCI治疗后两组患者均鼓励多饮水 ,慢性肾功能不全患者继续水化治疗 5～ 7d。③术前 2d开始每日口服阿司匹林和噻氯匹啶 ,用Judkins法行冠脉造影 ,按标准技术行PCI ,成功标准为靶病变惭余狭窄 <30 % ,且术中无严重合并症 (包括恶性心律失常、急性血栓形成、严重冠脉夹层、输血或心原性休克 )。使用非离子性造影剂 (优维显 370或安射力 35 0 )。④合并慢性肾功能不全患者PCI术后当天至出院前复查SCr ,所有患者记录术后心脏事件 ,出院后 3～ 6个月     

胱抑素C在判断糖尿病早期肾损害的作用

目的：探讨糖尿病肾病患者血清胱抑素C、血肌酐和尿微量白蛋白水平的变化及意义。方法：选取糖尿病肾病患者60例,单纯糖尿病患者65例,正常对照组55例,分别检测其尿微量白蛋白、血肌酐、血清胱抑素。结果：正常对照组与单纯糖尿病组三者比较差异无显著性（P〉0.05）;糖尿病肾病组与正常对照组及单纯糖尿病组比较尿微量白蛋白及胱抑素C差异显著（P〈0.01）,血肌酐水平无明显差异（P〉0.05）;糖尿病肾病组经辛伐他汀治疗1个月后,尿微量白蛋白、血清胱抑素C明显下降,与治疗前水平比较差异有显著性（P〈0.01）。结论：在糖尿病肾病早期肾功能损害中,CysC水平与尿微量白蛋白水有很好的相关性,是糖尿病肾病的敏感指标,且可以作为肾功能好转的指标。     

合并轻度肾功能不全冠心病患者行冠状动脉介入治疗效果分析

目的探讨合并轻度。肾功能不全（MRI）的冠心病患者经皮冠状动脉介入治疗（PCI）的疗效和安全性。方法选择238例住院行PCI的患者,根据肾小球滤过率（GFR）分为MRI组102例和肾功能正常组（对照组）136例,MRI组行静脉水化治疗。记录两组基本临床特征、介入手术情况和肾功能变化等资料并作统计学分析。结果两组合并病史情况、心力衰竭比例、手术成功率、手术时间、X线曝光时间、使用对比剂类型、靶血管分布、靶病变类型、植入支架数目、住院期间和6个月主要不良心脏事件发生率相似（P〉0．05）。MRI组年龄较大（P〈0．05）,体重较轻（P〈0．05）,对比剂用量较少（P〈0．05）,使用大剂量对比剂比例较小（P〈0．05）,对比剂肾病（CIN）发生率较高（P〈0．01）,差异有统计学意义。MRI组有1例CIN患者需行血液透析,但最终所有患者肾功能均能恢复至术前水平。两组不同时间血肌酐（Scr）和GFR比较均有明显差异（P〈0．01）,但组内比较差异无统计学意义（P〉0．05）。结论通过围手术期水化治疗、减少对比剂用量等适当处理,在合并MRI的冠心病患者中行PCI效果良好,安全性高。     

水化联合小剂量多巴胺预防对比剂肾病的初步研究

目的 探讨介入检查和治疗过程中水化联合小剂量多巴胺对对比剂肾病的预防作用.资料与方法 选择140例于2008年3月至2008年9月接受冠状动脉造影检查或治疗的患者,将其随机分为水化联合小剂量多巴胺研究组和水化治疗对照组.在水化治疗的基础上,研究组同时给予小剂量多巴胺(2μg·kg-1·min-1).检测所有患者术前、术后第2天、第3天血清肌酐(Crea)水平.结果 研究组有3例(4.29%)发生对比剂肾病,对照组有11例(15.7%).两组比较差异有统计学意义(P<0.05).结论 与单纯水化治疗相比,水化联合小剂量多巴胺可更显著地减少对比剂对肾功能的损害,对对比剂肾病的发生有一定的预防保护作用.     

对比剂对行PCI 术STEMI患者发生CIN及预后的影响

目的探讨对比剂对行经皮冠状动脉介入治疗(PCI)术对ST段抬高型心肌梗死(STEMI)患者发生对比剂肾病(CIN)及预后的影响。方法选取在2015年8月～2018年8月期间我院收治的SIEMI患者80例进行观察。采用随机数字表法,随机将患者分成观察组和对照组,每组均为40例。其中对照组采取低渗对比剂行PCI术,观察组则实施等渗对比剂行PCI术。之后比较两组患者不同时间点血清肌酐的水平、CIN的发生情况、CIN的影响因素及预后情况。结果观察组患者在术后24h、术后48h及术后72h的血清肌酐水平显著低于对照组(P0.05)。观察组术后CIN发生率(7.50%)显著低于对照组(25%)(χ~2=4.501,P0.05)。发生CIN组慢性肾功能不全患者比例及对比剂使用量上显著高于未发生CIN组,但是在入院血红蛋白水平上却显著低于未发生CIN组(P0.05)。入院血红蛋白、慢性肾功能不全及对比剂使用剂量是PCI术后发生CIN的独立影响因素。在PCI术后30天,两组患者在终点事件的总发生率差异无统计学意义(P0.05)。结论相比于低渗对比剂,等渗对比剂有利于降低行PCI对STEMI患者CIN的发生率且肾功能安全更高;入院血红蛋白、慢性肾功能不全及对比剂使用剂量是PCI术后发生CIN的独立影响因素。     

Adriamycin nephrosis and contrast media. A comparison between diatrizoate and iohexol in rats

Urine profiles (albumin, glucose, NAG, LDH, GGT and sodium) were followed for 9 days after intravenous injection of either diatrizoate, iohexol, or saline in 27 Wistar rats with nephrosis induced by Adriamycin 42 days before. Another 9 rats exposed to neither Adriamycin nor contrast media served as controls. None of the contrast media caused further increased albuminuria of significance, whereas both induced significantly increased excretion of all 5 tubular components. The excretion of NAG and sodium was significantly higher following diatrizoate than following iohexol. From 24 h post injection there was no significantly greater excretion of any of the components after either diatrizoate or iohexol than after saline among the rats given Adriamycin. At the end of day 9 after contrast medium injection neither serum sodium, potassium, glucose, urea, creatinine, nor albumin revealed any contrast media related changes. Kidney histology showed quantitatively larger lesions in kidneys exposed to Adriamycin and contrast media than in kidneys exposed to Adriamycin and saline. There were no differences between the two contrast media groups. It is thus concluded, that both high osmolar ionic and low osmolar non-ionic contrast media cause temporary tubular dysfunction but no further glomerular dysfunction in rats with nephrosis induced by Adriamycin. The histologic findings indicate that both media may worsen non-reversible renal lesions.     

Renal effects of the non-ionic contrast medium iopentol after intravenous injection in healthy volunteers

Renal effects of the new non-ionic contrast medium iopentol in increasing doses were assessed and compared with the effects of physiologic saline. Twenty-four healthy male volunteers, allocated to three dose groups, were given iopentol intravenously in doses of 0.3, 0.6, and 1.2 g I/kg body weight, respectively. The highest dose group was also given physiologic saline separately as a control. The diuresis increased in all groups, most in the highest dose group, and with a concomitant fall of urine osmolality and increase in osmolar clearance. A slight decrease of serum osmolality, creatinine and urea occurred at 3 hours due to hemodilution. The glomerular filtration rate was unaffected by iopentol. The urinary excretion of albumin and beta 2-microglobulin was unchanged. However, urinary N-acetyl-beta-glucosaminidase and alkaline phosphatase increased significantly, most in the highest dose group. All changes were reversible.     

Urinary protein excretion following intravenously administered ionic and non-ionic contrast media in man

Urinary protein excretion following intravenous administration of the radiographic contrast media (CM) diatrizoate (ionic) and iopromide (non-ionic) was examined in 20 patients with normal renal function. Neither of the two CM had any effect on the 24-h urinary excretion of albumin (a marker of glomerular proteinuria). The 24-h urinary excretion of the retinol-binding protein (a marker of low molecular weight or tubular proteinuria) and the folate binding protein, a protein localized in the brush-border membranes of the proximal tubular cells, showed a statistically significant transient increase the day after diatrizoate injection, whereas no increase was observed after iopromide. Thus, only a minimal and temporary disturbance of the renal proximal tubular function was observed after diatrizoate injection in patients with normal renal function.     

来氟米特联合科素亚与单纯应用科素亚治疗IgA肾病的对照研究

目的探讨来氟米特联合科素亚治疗IgA肾病的疗效。方法 40例IgA肾病患者按照就诊时间顺序分为单纯科素亚治疗组（科素亚组）及来氟米特联合科素亚治疗组（联合组）。分析两组治疗后1、3、6个月24 h尿蛋白定量、血浆白蛋白、肾功能变化及不良反应。结果治疗3个月时,与科素亚组[（1.28±0.49）g/d]比较,联合组[（0.92±0.53）g/d]能明显降低24 h尿蛋白定量,两组治疗前后差异有统计学意义（P〈0.05）。结论来氟米特联合科素亚治疗IgA肾病,较单纯应用科素亚能减少蛋白尿,延缓肾功能进展。     

Radiographic contrast media induced nephropathy: experimental observations and the protective effect of calcium channel blockers.

Combined acute inhibition of the synthesis of nitric oxide with L-nitroarginine methyl ester (L-NAME) and of prostacycline synthesis with indomethacin predisposes rats to severe renal injury from radiographic contrast media. The reliability of this pharmacological manipulation in the study of radiographic contrast medium induced nephropathy (RCMN) was investigated. Adult male Sprague-Dawley rats were injected with iv L-NAME (10 mg kg(-1)) and iv indomethacin (10 mg kg(-1)) 15 min apart and prior to injection of RCM or normal saline (control group). A dose-dependent reduction in renal function was observed after intravascular injection of the high osmolar RCM diatrizoate (Angiografin, 306 mgI ml(-1)). A significant (p<0.01) increase in serum creatinine (Cr) (from 54.66+/-8.39 micromol l(-1) to 171.96+/-24.49 micromol l(-1) and from 80.95+/-6.73 micromol l(-1) to 204.76+/-16.73 micromol (-1), n=5 per group) was observed 24 h after injection of 6 ml and 8 ml of diatrizoate, respectively. The increase in serum Cr after injection of 8 ml of diatrizoate recovered spontaneously to 80.87+/-8.70 micromol l(-1) 7 days after injection. No significant change in renal function was observed in the control group (n=5) receiving 8 ml kg(-1) of normal saline or after injection of 4 ml of diatrizoate (serum Cr 69.84+/-5.5 micromol l(-1) pre contrast injection and 66.67+/-13.47 micromol l(-1) 24 h post contrast injection, n=5). The increase in serum Cr observed with 6 ml of diatrizoate was significantly higher (p<0.01) than the rise induced by equivolume of the low osmolar non-ionic monomer iopromide (Ultravist, 300 mgI ml(-1)) (serum CR 68.47+/-8.39 micromol l(-1) pre contrast injection and 143.59+/-32.03 micromol l(-1) 24 h post contrast injection, n=5). The calcium channel blocker diltiazem (10 mg kg(-1) injected intraperitoneally 30 min prior to RCM injection) prevented the rise in serum Cr observed with 6 ml of diatrizoate (serum Cr pre contrast injection 70.31+/-7.28 micromol(-1) and 78.21+/-17.81 micromol(-1) 24 h post contrast injection in animals pre-treated with diltiazem, n=5). The protective effect against RCM-induced reduction in renal function was less with lower doses of diltiazem. In conclusion, the animal model used is reliable and reproduced previously established observations in the field of RCMN. The protective effect of a calcium channel blocker at the appropriate dose against RCMN has also been shown. The clinical effectiveness of this class of drugs in preventing RCMN requires further evaluation.     

Intravenous injection of ioxilan, iohexol and diatrizoate. Effects on urine profiles in the rat

Effects of intravenous ioxilan, a new third generation non-ionic contrast medium, diatrizoate, iohexol and saline on urine profiles were compared. Albumin, glucose, sodium, phosphate, and the enzymes NAG, LDH and GGT were followed in 24 normal rats over 7 days. Diatrizoate significantly affected all profile components during the first two hours. Albuminuria was significantly greater after diatrizoate than after iohexol or ioxilan, and excretion of glucose, LDH and GGT was significantly higher than after ioxilan. Both iohexol and ioxilan increased the excretion of albumin, LDH and GGT, while iohexol also significantly increased excretion of glucose and sodium. There was a greater excretion of glucose and GGT after iohexol than after ioxilan. Saline did not induce any changes. At day 7, serum sodium, urea, creatinine, and albumin were normal for all test substances, and kidney histology revealed no difference between the groups of animals. It is thus concluded that both high osmolar ionic and low osmolar non-ionic contrast media may cause temporary glomerular and tubular dysfunction in rats. In this model, the kidney is affected most by diatrizoate, less by iohexol, and least by ioxilan.     

缺血修饰白蛋白在冠状动脉介入术中的变化及意义

目的观察冠心病患者经皮冠状动脉介入术所诱导的短暂心肌缺血中血清缺血修饰白蛋白、血浆心肌肌钙蛋白T及心肌型肌酸激酶同功酶的浓度变化及其临床意义。方法123例行经皮冠状动脉介入术的冠心病患者,分别测定术前、术后3h血清缺血修饰白蛋白、血浆心肌肌钙蛋白T及心肌型肌酸激酶同功酶的水平,并与100例行冠脉造影证实为冠心病未行PCI患者以及93例行冠脉造影但证实冠脉正常患者术前、术后3h的上述指标的检测结果进行对比分析。结果123例经皮冠状动脉介入组的血清缺血修饰白蛋白术后3h较术前升高（P〈0.05）,而193例冠脉造影组的缺血修饰白蛋白术前术后无明显变化（P〉0.05）。3组血浆心肌肌钙蛋白T及心肌型肌酸激酶同功酶术前术后3h均无明显变化（P〉0.05）。结论缺血修饰白蛋白在可使心肌发生缺血缺氧损伤的经皮冠状动脉介入术后迅速升高,并早于心肌肌钙蛋白T。缺血修饰白蛋白是一个早期诊断心肌缺血的生化指标。     

Angiography for renal artery stenosis: no additional impairment of renal function by angioplasty

The aim of this study was to compare renal function between patients with renal angiography and patients with renal angiography and angioplasty (AP) for renal artery stenosis (RAS). Forty-seven patients with suspected RAS were prospectively investigated by digital subtraction angiography (DSA) using non-ionic low osmolar contrast media (CM). In 22 patients RAS was detected and in 16 cases an angioplasty was performed in the same session. The following parameters were determined 1 day prior to and after the DSA, respectively: serum creatinine (S-Crea, micromol/l) and single-shot inulin clearance (In-Cl, ml/min) for the evaluation of renal function; and urine alpha 1-microglobuline (AMG, microg/g Crea) and beta-N-acetyl-glucoseaminidase (beta-NAG, U/g Crea) as markers of tubular toxicity. Serum creatinine was measured additionally 2 days after CM had been injected. In both groups with and without AP 174+/-65 and 104+/-56 ml of CM ( p<0.0005) were used, respectively. There were no differences with regard to renal function or risk factors for CM nephrotoxicity between both groups. In the group with AP S-Crea and In-Cl (each: mean+/-SD) did not change significantly (before DSA: 171+/-158 and 61+/-24, after DSA: 189+/-177 and 61+/-25, respectively), beta-NAG (median) rose from 4 to 14 ( p<0.05) and AMG from 8 to 55 (n.s., because of high SD). In the group without AP S-Crea increased from 134+/-109 to 141+/-113 ( p<0.01), In-Cl dropped from 65+/-26 to 62+/-26 ( p<0,01), beta NAG (median) rose from 4 to 8 ( p=0.01), and AMG from 7 to 10 (n.s.). A rise in baseline S-Crea by more than 25% or 44 micromol/l occurred in 4 and 2 patients in the group with and without AP, respectively. Creatinine increase was reversible in all cases within 7 days. In this study using sensitive methods to detect changes of renal function and tubular toxicity no additional renal function impairment in DSA with angioplasty for RAS compared with DSA alone could be demonstrated. Our data suggest that AP performed for RAS has a beneficial effect on renal function.     

Renal effects of CO2 and iodinated contrast media in patients undergoing renovascular intervention: a prospective, randomized study

PURPOSE: CO2 gas has been proposed for use instead of iodinated contrast media in angiographic examinations in patients at risk of developing renal failure from contrast media. The influence of intraarterial injection of CO2 with small added amounts of ioxaglate (200 mgI/mL) or ioxaglate alone on renal function in patients with suspected renal artery stenosis was studied in a prospective, randomized study. MATERIALS AND METHODS: One hundred twenty-three patients underwent renovascular intervention (n = 83) and/or renal angiography (n = 40) for suspected renal artery stenosis. Patients with a serum creatinine concentration less than 200 micromol/L (n = 82) were randomized prospectively to receive CO2 with small added amounts of ioxaglate (n = 37) or only ioxaglate (n = 45). Patients with serum creatinine levels greater than 200 micromol/L (n = 41) were not randomized and initially received CO2. Serum creatinine concentrations were measured within 1 day before and 1 day, 2 days, and 2-3 weeks after the procedure. RESULTS: The amount of injected CO2 did not relate to an increase in serum creatinine level. In the randomized groups, and also when the whole patient sample was considered, the amount of injected iodine was significantly correlated (P = .011) with an increase in serum creatinine level and a decrease in estimated creatinine clearance after 2 days. Among the randomized patients, one in the CO2 group and three in the ioxaglate group had a more than 25% increase in serum creatinine level within the first 2 days after the intervention. CONCLUSION: The risk of impairment of renal function is lower after injection of CO2 with small amounts of added ioxaglate compared with injection of a larger amount of ioxaglate alone. The larger the amount of administered iodinated contrast medium, the greater the risk of development of renal failure.