碘佛醇、碘克沙醇和碘普罗胺对充血性心力衰竭患者肾功能的影响  

Effects of ioversol,iodixanol and iopromide on renal function in patients with congestive heart failure

作　　者：王胜奇[1] 汪爱丹 王晶[1] WANG Sheng-qi;WANG Ai-dan;WANG Jing(Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100045, China;Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100045, China)

机构地区：[1]首都医科大学宣武医院急诊科,北京100045 [2]首都医科大学宣武医院放射科,北京100045

出　　处：《临床药物治疗杂志》2019年第3期25-29,共5页Clinical Medication Journal

摘　　要：目的:观察碘佛醇、碘克沙醇和碘普罗胺对充血性心力衰竭患者肾功能的影响。方法:选取2017年3—12月入住首都医科大学宣武医院行强化CT的充血性心力衰竭患者198例,随机分为碘佛醇组64例、碘克沙醇组65例与碘普罗胺组69例。所有入组患者均在行强化CT检查前及检查后第5、10天查血肌酐(serum creatinine, SCr)、尿素氮(blood urea nitrogen, BUN)及尿微量白蛋白与肌酐比值(urinary albumin/creatinine ratio,mAlb/Cr),计算肾小球滤过率(estimated glomerular filtration rate, eGFR),比较3组肾功能指标变化及造影剂肾病(contrast-induced nephropathy,CIN)发生率。结果:强化CT检查5d后3组患者SCr、BUN及mAlb/Cr均较检查前升高(P<0.05),eGFR较检查前降低(P <0. 05)。检查10 d后碘佛醇组mAlb/Cr与eGFR、碘普罗胺组mAlb/Cr仍未恢复至检查前水平(P<0.05);强化CT检查5d后碘克沙醇组SCr、mAlb/Cr明显低于碘佛醇组(P<0.05), eGRF明显高于碘佛醇组(P<0.05);碘普罗胺组eGFR明显高于碘佛醇组(P<0.05)。碘佛醇组CIN发生率明显高于碘克沙醇组(P<0.05),但与碘普罗胺组CIN发生率无明显统计学差异(P>0.05)。结论:在充血性心力衰竭患者中选择等渗造影剂(如碘克沙醇)可以减低CIN发生率,造影剂黏度对CIN影响较小。Objective: To observe the effects of ioversol, iodixanol, and iopromide on renal function in patients with congestive heart failure. Methods: A total of 198 patients with congestive heart failure(CHF) who prepared for enhanced CT examination were randomly divided into ioversol group(64 cases), iodixanol group(65 cases), and iopromide group(69 cases). All the patients were admitted to Xuanwu Hospital, Capital Medical University from March to December 2017. The blood urea nitrogen(BUN), creatinine(Scr), and urinary albumin/creatinine ratio(mAlb/Cr) were checked before and 5, 10 days after the CT scan, respectively. The glomerular filtration rates(eGFR) were calculated.The renal function indexes, incidences of contrast-induced nephropathy( CIN) were compared among the 3 groups. Results: The levels of SCr, BUN, and mAlb/Cr after 5 days of enhanced CT examination were higher than that before in each groups(P <0. 05), while the eGFR was lower than that before(P<0.05). The mAlb/Cr, eGFR of ioversol group and the mAlb/Cr of iopromide group did not recover after 10 days of enhanced CT examination(P < 0. 05). The SCr and mAlb/Cr of iodixanol group were significantly lower than that of ioversol group 5 days after CT examination(P < 0. 05),while the eGRF was significantly higher(P <0. 05). The SCr of iopromide group was significantly lower than that of ioversol group(P <0. 05). The incidence of CIN was significantly higher in ioversol group than that in iodixanol group(P < 0. 05), but there was no significant difference between iopromide group and ioversol group(P>0. 05). Conclusion: Isotonic contrast agents(iodixanol) can reduce the incidence of CIN in patients with CHF. The viscosity of the contrast media has little effect on CIN.

关 键 词：造影剂肾病 充血性心力衰竭 碘佛醇 碘克沙醇 碘普罗胺 

分 类 号：R981.1[医药卫生—药品]