前列地尔对重复使用对比剂所致肾损伤的防治作用  

Renoprotective effect of alprostadil on renal injury caused by repeated use of the contrast media

作　　者：柴婵娟[1] 杨志明[1] 李瑾[1] 巩书文[1] 边云飞[1] 王艳庆[1] 朱国斌[1] 

机构地区：[1]山西医科大学第二医院心内科,山西太原030001

出　　处：《中国介入心脏病学杂志》2016年第6期334-338,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的 观察重复使用对比剂对肾的影响及前列地尔对对比剂肾病（CIN）有无防治作用。方法 选取80例接受过对比剂检查,因病情需要在1个月内再次使用对比剂的成年患者,随机分为两组,分别进入单纯水化组（40例）及水化联合前列地尔组（40例）。观察两组患者首次造影术前后及再次造影术前后尿素氮、肌酐、肌酐清除率、胱抑素C及尿β微球蛋白水平及CIN发生率的变化。结果 单纯水化组中与造影术前比较,无论首次造影术后还是再次造影术后,尿素氮、肌酐、胱抑素C及β微球蛋白水平均显著升高,肌酐清除率下降（均P〈0.05）;但再次造影术后与首次造影术后CIN发生率（15.0%比2.5%,χ^2=2.505,P=0.113）差异无统计学意义。水化联合前列地尔组再次造影术后尿素氮[（7.4±2.3）mmol/L比（9.1±2.6）mmol/L]、肌酐[（87.2±25.6）μmol/L比（96.9±25.8）μmol/L]、胱抑素C[（0.8±0.3）mg/L比（1.4±0.3）mg/L]、尿β微球蛋白[（207.0±31.9）μg/L比（279.3±37.3）μg/L]较单纯水化组再次造影术后显著下降,而肌酐清除率有所提升[（92.2±24.2）ml/min比（78.2±27.5）ml/min],差异均有统计学意义（均P〈0.05）;但再次造影术后与首次造影术后CIN发生率（7.5%比2.5%,χ^2=0.263,P=0.598）,差异无统计学意义。水化联合前列地尔组再次造影术后CIN发生率（7.5%比15.0%,χ^2=0.501,P=0.479）与单纯水化组再次造影术后比较,差异无统计学意义。结论 使用对比剂对肾功能有一定影响,而短期重复使用对比剂加重对肾功能的损伤,但不增加CIN发生率;在使用水化联合前列地尔后,能显著减轻对比剂对肾的损伤作用。Objective To study the effect on renal function about repeated use of contrast media, and whether alprostadil has protective effect towards contrast-induced nephropathy （ CIN）. Methods 80 adult patients who had ever received contrast examination and scheduled to have PCI within 1 month were randomly divided into two groups： the simple hydration group and the hydration plus alprostadil therapy group. The serum level of creati-nine, urea, Cystatin C, Urine β-microglobulin and creatinine clearance were recorded and compared between the two groups, and were observed before and after repeated exposure of contrast medium. The incidence of CIN was analyzed. Results Compared with pre-contrast levels, serum levels of urea, creatinin, Cystatin C and Urine β-microglobulin all elevated after single and repeated contrast media use in patients in the simple hydration group （ P 〈 0. 05 ）. The incidence of CIN did not differ after single or repeated contrast used （2. 5% vs. 15.0% , P 〉0. 05）. After repeated contrast exposure compared with patients with simple hydration, patients in the alprostadil group had repeated serum levels of urea [（7.4±2.3） mmol/L vs. （9.1±2.6） mmol/L], creatinia [（87.2±25.6） μmol/L vs. （96.9±25.8） μmol/L], Cystatin C [ （ 0. 8 ± 0. 3 ） mg/L vs. （ 1.4 ±0. 3 ） mg/L] and Urine 13-microglobalin [ （207.0±31.9 ） μg/L vs. （ 279. 3 ±37. 3 ）μg/L ] were all lower with higher creatinin clearance [ （ 92. 2 ±24. 2） ml/min vs. （78.2 ± 27.5） ml/min ] （ all P 〈 0. 05 ）. The incidence of CIN in patients with alprostadil did not differ after single or repeated contrast used （2. 5% vs. 7.5% , P 〉0. 05）. The incidence of CIN in patients treated with alprostadil had no difference compared with patients with simple hydration after repeated contract （7.5% vs. 15.0%, χ^2 =0.501,P=0.479）. Conclusions Contrast media can cause damage to renal function. Short-term repeated use of contrast media can further worsen renal function without signifi

关 键 词：对比剂肾病 前列地尔注射液 前列腺素E 肾功能 

分 类 号：R692[医药卫生—泌尿科学]