造影剂肾病临床相关因素分析

目的探讨造影剂肾病(radiocontrast-induced nephropathy,RCIN)的临床相关因素及其转归。方法回顾性分析住院行冠脉造影及介入治疗患者1062例,比较临床特点、造影剂使用剂量和造影前后血清肌酐的变化。结果RCIN总发生率11.0%(117/1062),糖尿病合并肾功能不全的患者中RCIN发病率为62.5%(45/72),超安全剂量使用RCIN发病率70.9%。单因素Logistic回归分析显示,与发生RCIN相关的因素分别是慢性充血性心功能不全、慢性肾功能不全,尤其是与糖尿病合并肾功能不全相关,与年龄、性别、高血压和术日的出入量无关,RCIN的临床表现多为非少尿型肾功能不全,造影后第2～3天Scr、Ccr水平与造影前相比差异有统计学意义,而7d后差异无统计学意义。结论术前的肾功能(术前的Scr、Ccr)、心脏功能、是否合并糖尿病、使用造影剂的剂量是RCIN发生的危险因素,术后必须监测肾功能的变化,给予对症支持大多数患者的肾功能可以恢复。

A Report about the Causing Factors of Radiocontrast-induced Nephropathy

Objective To explore the causing factors and prognosis of radiocontrast-induced nephropathy(RCIN). Methods 1 062 cases of coronary angiography and interventional management were retrospectively analyzed,and the clinical features,the dose of radiocontrast medium,and the alteration of serum creatinine before and after angiography were compared. Results The total mortality rates of radiocontrast-induced nephropathy were 11.0%(117/1 062);in patients with preexisting diabetic renal dysfunction,the RCIN rate was 62.5%(45/72);in patients with contrast medium overdose,RCIN rates were 70.9%;the monofactor Logistic analysis showed that the factors causing RCIN were chronic congestive heart failure,chronic renal failure,and especially diabetic renal dysfunction,however,the factors such as age,gender,hypertension,and the intake and output volume on the day of intervention were irrelative with RCIN.The clinical features of RCIN mostly included renal failure without oliguria.2 to 3 days after angiography the serum creatinine(Scr)and creatinine clearance rate(Ccr)changed dramatically,however,they returned to the level before angiography after 7 days . Conclusion The preoperative renal function(Scr and Ccr),cardiac condition,preexisting diabetes,and the dose of contrast medium were risk factors of RCIN.Postoperative monitoring of renal function was necessary.With prompt symptomatic management,the renal function in most cases could be recoverd.