4种造影剂所致药物性肾损害的回顾性研究  

Retrospective Study on Renal Impairment Induced by Contrast Mediums

作　　者：李晓红[1] 张胜容[2] 

机构地区：[1]北京中医药大学,2000级七年制北京市100029 [2]北京中医医院肾病科,北京市100010

出　　处：《中国医院用药评价与分析》2008年第9期701-703,共3页Evaluation and Analysis of Drug-use in Hospitals of China

摘　　要：目的：分析部分造影剂所致药物性肾损害的危险因素，指导临床防治。方法：对我院2003～2006年231例使用单聚体非离子型造影剂碘普罗胺行冠脉造影检查的病历、66例使用单环非离子型造影剂碘苯六醇行增强CT检查的病历、30例使用顺磁性造影剂钆喷酸葡胺行增强核磁检查的病历、39例行核素放射检查的病历进行回顾性调查，根据用药前后的各项实验室检查结果对比，对是否存在药物性,肾损害进行评估分析。主要研究终点为出现肾功能损害，次要研究终点为出现肝功能和造血系统损害。结果：使用碘普罗胺的患者有7例（3．03％）出现肾功能异常；使用碘苯六醇的患者有1例（1．51％）出现肾功能异常；使用核素的患者有4例（10．26％）出现肾功能异常；使用钆喷酸葡胺的患者无一例出现肾功能异常。结论：非离子造影剂有一定的肾毒性，其中单聚体非离子型造影剂碘普罗胺使用后发生肾损害的主要危险因素为患者的基础血肌酐水平，Scr〉90／μmol·L^-1的患者出现肾功能损害的危险系数更高；使用单环非离子型造影剂碘苯六醇和放射核素造影检查也可造成造影剂肾损害，但其危险因素在本研究中不明显；使用顺磁性造影剂钆喷酸葡胺进行增强核磁检查相对安全，不易发生造影剂肾损害。OBJECTIVE： To analyze the risk factors of renal impairment induced by some contrast mediums to guide clinical prevention and cure of renal impairment. METHODS： Between 2003 and 2006J, the case histories of 231 Iopromide （monomeric non - ionic contrast agent） users for coronary arteriongraphy, 66 Iohexol users for enhanced CT scan, 30 Dimeglumine Gadopentetate （paramagnetic） users for enhanced MRI and 39 Nuclide users were investigated retrospectively. The renal lesion was analyzed and evaluated based on laboratory tests before and after medication. The primary end point was renal impairment and the secondary end point was lesion of liver function and hematopoietic system. RESULTS： Renal impairment was noted in 7 Iopromide users （3.03 % ）, 1 Iohexol user （1.51 % ）, 4 Nuclide users （10.26%）, and none of Dimeglumine Gadopentetate users. CONCLUSION： Nonionic contrast medium can has nephrotoxicity. The major risk factor of renal impairment in Iopromide users is the baseline level of Scr, higher risk coefficient involved if Scr 〉 90μmol/L. Iohexol and Nuclide also can induce renal impairment, but the risk factors were not significant in this study. Dimeglumine Gadopentetate is safer and unlikely to cause renal impairment.

关 键 词：造影剂 肾损害 肝功能损害 造血系统损害 危险因素 

分 类 号：R969.3[医药卫生—药理学]