老年患者增强CT检查所致肾损伤的危险性评价及糖尿病对其影响  

The risk evaluation on constrast-induced renal impairment and the influence of diabetes in the elderly

作　　者：苗雅[1] 钟远[1] 燕虹[1] 李蔚[1] 王蓓芸[1] 金俊[1] 

机构地区：[1]上海交通大学附属第六人民医院老年科,上海市200233

出　　处：《老年医学与保健》2013年第1期44-48,共5页Geriatrics & Health Care

基　　金：上海交通大学附属第六人民医院院级科研基金（1159）

摘　　要：目的研究老年患者增强CT检查所致的肾损害的情况及糖尿病对其影响。方法纳入符合入组条件的患者129例，其中糖尿病组40例，无糖尿病组89例。所有患者于增强CT检查前、检查后24h和48h留取静脉血检测。肾功能参数：血肌酐（Scr）、血尿素氮（BUN）和半胱氨酸蛋白酶抑制剂C（CysC），根据Cockroft-Gault公式计算Ccr。取造影剂应用后24h、48h各。肾功能指标最高值作为其峰值，各指标的峰值与造影剂应用前相应肾功能指标的差值作为APeak（AScr、ACcr、ABUN和ACysC）。对比所有入组患者增强CT检查前后的。肾功能参数，并对糖尿病和无糖尿病患者进行分组，对比两组患者增强CT检查后肾功能参数的变化。结果入组患者平均年龄（77．6±6．6）岁。所有入组老年患者，增强CT检查后24hScr[（88．16±20．54）vs（82．07±20．06），P=0．017]和CysC[（1．61±0．42）vs（1．40±O．36），P〈0．001]较造影前升高。所有入组老年患者，造影后48hScr、Ccr、BUN和CysC与造影前比较虽有差别，但无统计学意义。造影后峰值与造影前肾功能指标相比，Scr[（90．57±20．75）VS（82．07±20．06），P=0．001]和CysC[（1．65±O．50）vs（1．40±0．36），P〈0．001]均升高，Ccr较造影前降低[（58．71±16．19）VS（63．15±17．06），P=0．033]。应用造影剂后，糖尿病组AScr[（10．38±7．77）vs（7．65±6．23），P=0．036]和ACysC[（0．34±0．20）vs（0．21±0．27），P=0．009]均高于无糖尿病组。结论老年患者增强CT检查有明显的肾功能损害，造影剂应用后24h最明显，除年龄外，糖尿病是老年造影剂。肾脏损伤的重要危险因素之一。Objective To evaluate renal impairment of enhanced CT examination and the influence of diabetes in the elderly. Methods A total of 129 patients were involved in the study, including 40 diabetic and 89 non-diabetic participants. Before and （24 hours and 48 hours） after enhanced CT examination, serum creatinine （Scr）, blood urea nitrogen （BUN）, Cystatin C （CysC） and Creatinine clearance （Ccr） were analyzed or calculated. AScr was got from the change of the baseline and highest Scr, as well as ACcr, ABUN and ACysC. The renal function parameters before and after enhanced CT examination were compared in the total older cohort and the difference of the groups in diabetic and non-diabetic groups were analyzed. Results The average age of the enrolled patients was （77.60±6.64） years. In the 129 elderly, the 24- hours Scr [（88.16±20.54） vs （82.07±20.06）, P=0.017] and CysC [（1.61±0.42） vs （1.40±0.36）, P〈0.001] increased significantly, compared with the baseline values, before enhanced CT examination. The differences of Scr, Ccr, BUN and CysC could be found between the baseline values and the 48-hour values, but they failed to reach the statistical significance. The peak of Scr [（90.57±20.75） vs （82.07±20.06）, P=0.001] and CysC [（1.65 5.0.50） vs （1.40±0.36）, P〈 0.001] were higher than its baseline values, but the peak of Ccr [（58.71± 16.19） vs （63.15 ± 17.06）, P=0.033] was lower than its baseline value. We also found that AScr [（10.38 ±7.77） vs （7.65 ±6.23）, P=0.036] and ACysC [（0.34±0.20） vs （0.21±0.27）, P=0.009] in the diabetic group were higher than those in the non-diabetic group after contrast-enhanced CT examination. Conclusions Contrast agents in enhanced CT examination could cause renal injury in older cohort, which could be easily found 24 hours after contrast application. Other than age, diabetes is one of the important risk factors for contrast-induced renal injury in the elderly.

关 键 词：造影剂肾病 糖尿病 增强CT 老年人群 

分 类 号：R814.42[医药卫生—影像医学与核医学]