低渗非离子造影剂对冠状动脉介入诊疗术患者肾功能影响的前瞻性研究

目的 了解低渗非离子造影剂对冠状动脉介入诊疗术患者肾功能的影响，造影剂肾病(CIN)的发病率及危险因素。 方法 2004年12月至2005年3月期间住院的315例接受冠状动脉介入诊疗手术的患者入选，所有患者均应用低渗非离子造影剂。测定造影前3 d内和术后第1、2、6天肾功能、尿N-乙酰-β氨基葡萄糖苷酶(NAG)、尿渗透浓度，分析造影剂对冠状动脉介入诊疗术患者肾功能的影响。Logistic多因素回归分析影响CIN发生的危险因素。 结果 (1)315例患者中，男性231例，女性84例，平均年龄(63.5±11.6)岁，发生CIN 19例，发病率6.03%。在既有肾功能不全又有糖尿病组中，CIN发病达4/8，与无肾功能不全、有或无糖尿病组比较，差异有统计学意义(P < 0.05，P < 0.01)。(2)19例CIN患者中，造影后第1、2天，尿NAG、Scr均显著高于造影前水平(P < 0.05)，但造影后第6天基本回复至基础水平。(3)CIN组中原有肾功能不全者达9/19，非CIN组为31/296(10.5%)，两组比较差异有统计学意义(P < 0.01)。平均造影剂剂量CIN组为(318.4±153.8) ml，非CIN组为(227.9±121.9) ml， 两组比较差异有统计学意义(P < 0.01)。Logistic逐步回归分析显示，造影剂剂量和合并肾功能不全是CIN的独立危险因素。结论 CIN在原有肾功能不全特别是合并糖尿病的人群中发病率较高。尿NAG可反映早期肾小管功能损害。造影剂剂量和合并肾功能不全是CIN的独立危险因素。

Effect of the low-osmolality nonionic contrast media on renal function in patients undergoing coronary intervention: a prospective study

Objective To analyse the effect of the low osmolar nonionic contrast medium on renal function in patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI). To study the incidence and risk factors of contrast-induced nephropathy (CIN). Methods Three hundred and fifteen patients undergoing PCI or coronary-angiography from December 2004 to March 2005 were enrolled in this study. All patients received low-osmolality nonionic contrast agent. Scr， N-acetyl-β-D-glucosaminidase (NAG) and the osmolality of urine were measured at any time three days before the angiography and at 1， 2 and 6 days post procedure. Multivariate predictors of contrast-induced nephropathy were determined using logistic regression. Result (1)Among the 315 patients， 231 were males and 84 females. The average age was (63.5±11.6) years. Nineteen patients (6.03%)experienced CIN and the incidence of CIN was 6.03%. In those who had both DM and renal insufficiency， the incidence of CIN was 4/8， which was significantly higher than those who had normal renal function and/or DM (P < 0.05，P < 0.01)； (2) In 19 patients who had CIN， the level of urine NAG and Scr at day 1 and 2 post angiography were higher than those before the procedure (P < 0.05)， but they were decreased to normal level at day 6 following angiography. (3)The incidence of previously recorded renal dysfunction was 9/19 in CIN patients and 10.5% (31/296)in non-CIN patients， respectively (P < 0.01). The average contrast volume was (318.4±153.8)ml in CIN group whereas (227.9±121.9) ml in non-CIN group， and significant difference was found between the two groups(P < 0.01). Identified by logistic regression， the volume of contrast agent and pre-existed renal dysfunction were independent risk factors of contrast-induced nephropathy. Conclusions The incidence of CIN in patients who had renal dysfunction combining with DM previously is higher than that in other patients. The urinary NAG indicates early impact of renal tubular function. The volume of contrast and pre-existed renal dysfunction are independent risk factors of contrast-induced nephropathy.