静脉注射对比剂钆喷替酸葡甲胺对肾功能正常及轻、中度异常者近期血清肌酐值的影响

目的 探讨静脉注射对比剂Gd-DTPA对常规MR增强扫描人群肾功能的影响.方法 连续收集门诊住院病例623例,均注射Gd-DTPA行MR增强扫描检查的病例进行研究,检测患者增强扫描前2周内的基础血清肌酐值以及增强扫描后24～72 h内的血清肌酐值,并计算其肾小球滤过率估算值(eGFR)进行分组及统计分析.根据注射对比剂剂量将患者分为常规剂量组和双倍剂量组,各组根据注射前eGFR值再各分为肾功能正常、轻度异常及中度异常组.对各组注射前后血清肌酐值的比较均使用配对样本的t检验,eGFR均值的比较均使用成组配对样本秩和检验.结果 无患者出现严重不良反应及严重肾功能衰竭.注射对比剂后,总体血清肌酐值从(74.0±17.2)μmol/L降至(71.5±19.0)μmoL/L(t=5.39,P＜0.05);除双倍剂量下肾功能轻度组的血清肌酐值从(89.6±12.2)μmoL/L升至(92.1±14.6)μmol/L(t=0.68,P＞0.05),肾功能中度异常组从(118.3±15.3)μmol/L升至(135.7±8.5)μmol/L(t=2.02,P＜0.05)之外,肾功能正常组以及常规剂量下各组的血清肌酐值均降低.结论 Gd-DTPA在常规剂量下经静脉注射对肾功能正常及轻、中度异常者的近期血清肌酐值影响不大,是一种比较安全的MR对比剂.但对于肾功能异常者行双倍剂量注射时需密切观察并随访.

Evaluation the short term effects on serum creatinine concentration in patients with normal renal function, mild and moderate renal insufficiency after intravenous injection of gadopentetate dimeglumine

Objective To explore the effects of gadopentetate dimeglumine injection on renal function. Methods The study included 623 consecutive patients. Their serum creatinine concentrations before and within 3 days after injection of gadopentetate dimeglumine were analyzed. Their eGFR ( estimated glomerular filtration rate) were calculated. Patients were divided into two groups according to their injection dose: group received single dose and group received double dose. Patients in each group were subdivided into three subgroups according to their eGFR: subgroup of normal renal function, subgroup of mild renal insufficiency and subgroup of moderate renal insufficiency. Paried sample t test and group design paried sample Rank Sum test were used for statistical analysis. Results There was no adverse reaction oroccurrence of acute renal insufficiency. The mean level of serum creatinine dropped from (74. 0 ±17. 2) μ mol/L to (71.5 ± 19. 0) μ mol/L (t = 5. 39, P ＜ 0. 05 ) in 623 cases after injection of gadopentetate dimeglumine. However, the mean level of serum creatinine increased from (89.6 ± 12. 2 ) μmol/L to (92. 1 ± 14. 6) μmol/L ( t = 0. 68, P ＞ 0. 05 ) in subgroup of mild renal insufficiency under group received double dose and increased from ( 118. 3 ± 15. 3 ) μmol/L to ( 135.7 ± 8. 5 ) μ mol/L ( t = 2. 02, P ＜ 0. 05 ) in subgroup of moderate renal insufficiency under group received double dose, the mean level of serum creatinine dropped in all other subgroups. Conclusions Single dose gadopentetate dimeglumine is safe for patients with normal renal function and mild, moderate renal insufficiency in short term, but patients with abnormal renal function should be followed up after double dose injection.