连续性血液净化救治对比剂急性肾损伤的临床研究  

The Clinical Research of Contrast Agent-induced Acute Renal Injury with Treatment of Continuous Blood Purification

作　　者：孟建中[1] 荣鹏[1] 周春华[2] 王素霞[1] 刘文渊[1] 景颖[1] 贾凤玉[1] 葛彦明[1] 岳冀[1] 

机构地区：[1]中国人民解放军济南军区总医院,济南250031 [2]中国人民解放军海军总医院,北京100023

出　　处：《生物医学工程研究》2011年第4期244-247,共4页Journal Of Biomedical Engineering Research

摘　　要：研究连续性血液净化(CBP)救治对比剂急性肾损伤(CI-AKI)的临床特点。选取2003年5月至2010年5月间救治的32例CI-AKI患者,分析发病规律,检测造影前、后及CBP救治前、后其血肌酐(Cr)、尿酸(UA)、高敏C反应蛋白(hs-CRP)等生化指标的动态变化,观察患者28 d的病死率。结果表明(1)发病规律:17例(53.13%)冠心病并存糖尿病患者在接受心导管治疗后发生CI-AKI,其中13例(40.62%)同时服用双胍类降糖药。(2)临床特点:造影术后24 h,患者尿酸及hs-CRP水平明显增高,在48 h达高峰;而血肌酐水平则在造影术后48 h增高,在术后72 h达高峰。经相关性分析发现,血尿酸水平与hs-CRP含量变化呈现正相关(r=0.66,P<0.05)。(3)转归:29例(90.62%)患者在CBP治疗48h脱离少尿期,人/肾均得以生存。2例(6.25%)因肾脏死亡,现依赖维持性透析生存。死亡1例(3.12%),死亡原因为PCI术后12 d,发生恶性心律失常。PCI术前,糖尿病患者服用双胍类降糖药是CI-AKI的独立危险因素。血尿酸及hs-CRP水平变化是反映CI-AKI细胞损伤的敏感指标之一。CBP能够改善肾脏灌注,加快对比剂和尿酸的排泄,降低肾小管上皮细胞的氧化应激反应,保护肾功能。To study the clinical features of Contrast agent-induced acute renal injury(CI-AKI) with treatment of continuous blood purification(CBP).32 cases of CI-AKI patients we treated from May 2003 to May 2010 were selected.We analyzed the pathogenesis,detected the continuous changes of the levels of serum creatinine(Scr),uric acid(UA),high-sensitivity C-reactive protein(hs-CRP) and other biochemical indicators before and after imaging and before and after CBP treatment,observed the mortality of CI-AKI patients in 28 days.The law of the incidence: 17 cases with coronary heart disease with diabetes suffered from CI-AKI after receiving treatment in the cardiac catheterization.Among them,13 cases(40.62%) while taking biguanide hypoglycemic agents.Clinical features: At 24h after angiography,uric acid and hs-CRP levels were significantly increased,and peaked at 48h.The Scr level increased at 48h after angiography,and reached a peak at 72h after surgery.The correlation analysis showed that serum uric acid levels and changes in hs-CRP levels showed a positive correlation(r=0.66,P<0.05).Outcome:29 cases(90.62%) patients out of oliguria after 48h in CBP treatment,people/kidney were to survive.2 cases(6.25%) due to renal failure,survival was dependent on maintenance dialysis.1 patient died(3.12%) of malignant arrhythmia after PCI,12 d.Biguanide hypoglycemic is an independent risk factor in diabetic patients suffering from CI-AKI after PCI.The changes of Serum uric acid and hs-CRP levels are sensitive indicator reflect cell damage in CI-AKI.CBP can improve renal perfusion,accelerate the excretion of uric acid and contrast agent,reduce the effect of oxidative stress in the renal tubular epithelial cells,protect renal function.

关 键 词：对比剂 急性肾损伤 连续性血液净化 高敏C反应蛋白 

分 类 号：R318[医药卫生—生物医学工程]