造影剂对慢性肾功能不全患者的肾毒性  

A prospective study of contrast nephrotoxicity in patients with chronic renal failure

作　　者：段绍斌[1] 刘伏友[1] 彭佑铭[1] 罗季安[1] 蒋云生[1] 夏运成[1] 陈立平[1] 

机构地区：[1]中南大学湘雅医学院附二院肾内科,长沙410011

出　　处：《肾脏病与透析肾移植杂志》2001年第2期130-132,共3页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：湖南省卫生厅课题经费 (No .973 5 );中南大学湘雅医学院附二院启明星计划基金 (No .2 0 0 0 11)资助

摘　　要：目的 :研究慢性肾功能不全患者造影剂相关性肾病 (CAN)的发生率和临床特征 ,探讨内皮素 (ET1)和一氧化氮 (NO)在CAN中的作用。　 方法 :观察 13例原有慢性肾功能不全患者造影前后血清肌酐 (SCr)及尿ET1和NO水平变化。CAN诊断标准为造影后SCr较基础值增加 2 5 %和 88 4μmol/L。　 结果 :使用造影剂后SCr均升高较基础值净增 90 6～ 736 μmol/L(平均 2 5 4 6 μmol/L)。CAN的发生率为 6 1 5 %。SCr上升峰值时间为第 3～ 7天(平均 5天 ) ;恢复至基础水平的时间为第 10～ 45天 (平均 2 0天 ) ,6例患者SCr未恢复至基础水平。造影后尿ET1水平显著增高 ,NO水平下降 ,ET1/NO水平显著增高 (P均小于 0 0 1)。　 结论 :慢性肾功能不全患者使用造影剂后肾衰均加重 ,ET1和NO的失衡可能在造影剂肾病的发病中起重要作用。Objective:To investigate the prevelence and characteristics of contrast nephrotoxicity(CNT)in patients with chronic renal failure(CRF),and to evaluate the role of endothelin 1(ET 1)and nitric ozide(NO)in CAT. Methodology:In this study,thirteen patients with established diagnosis of CRF(base line serum creatinine level between 238～599 μmol/L) were subjected to the examination for elucidating the nephrotoxic effect of the contrast medium.The diagnostic criteria for CNT after the radiographic examination was mainly including an increment of 25% of the base line serum creatinine or 88 4 μmol/L in serum creatinine level.Urinary ET1 and NO levels were measured before and 24 hours after the application of contrast medium in 11 of the 13 patients. Results:Established CNT was found in 8(61 5%)of the 13 CRF patients.The peak increased serum creatinine level was observed between the 3 rd and the 7 th day after useing of contrast media.The return of serum creatinine to base line level could be found on 10 th to 45 th day after the use of contrast media.Urinary ET1 level was found significantly increasing in all the 11 patients after contrast,and the value of ET1/NO ratio was high as well. Conclusion:Using the contrast media in CRF patients can exacerbate the damage of renal function application with an incidence of 61 5%.Disturbance of the balance of ET1 and NO might play a role in the pathogensise of CAN in these patients.

关 键 词：造影剂 肾毒性 肾功能衰竭 

分 类 号：R692.5[医药卫生—泌尿科学]