摘要
目的观察老年患者使用低渗非离子造影剂冠状动脉造影（CAG）检查后造影剂肾病（CIN）的发病率，并探讨老年人发生CIN的危险因素。方法老年患者195例，造影前6h和造影后12h使用静脉等渗生理盐水（1ml·kg^-1·h^-1）水化，有明显心功能衰竭患者剂量减半；测定造影前3d内和造影后第2、5天血肌酐、血清胱抑素C（cystatin C）。结果（1）195例老年患者中，发生CIN 17例（8．7%）；造影后3个月，11例血肌酐恢复到术前水平；2例转变为慢性肾衰竭，但不需要肾脏替代治疗；3例肾功能持续恶化，需要维持血液净化治疗；1例因多脏器功能衰竭死亡。（2）造影后第2天血清cystatin C与造影前比较，差异无统计学意义（t=0．137，P=0．891）；而造影后第2天血肌酐（89．3±33．8）μmol／L，与造影前（100．14±18．9）μmol／L比较明显下降，差异有统计学意义（t=4．776，P=0．000）；造影后第5天血清cystatin C、血肌酐均恢复到术前水平。（3）发生与未发生CIN患者其性别、造影剂剂量、基线血肌酐、冠心病比例，差异无统计学意义；而年龄、基线cystatin C、糖尿病、高血压、充血性心力衰竭，差异有统计学意义。（4）多因素Logistic回归分析表明，充血性心力衰竭（OR=9．597）、糖尿病（OR=8．104）、基线cystatin C（OR=6．654）、基线血肌酐（OR=1．039）是CIN发生的临床危险因素。结论老年患者在充分水化后使用低剂量低渗非离子型造影剂，具有较高安全性；发生CIN的危险因素为充血性心力衰竭、糖尿病、基线cystatin C、基线血肌酐；血清cystatin C与血肌酐比较，预测CIN强度更高。
Objective To investigate the incidence of contrast induced nephropathy （CIN） in the elderly undergoing coronary angiography and the correlated clinical risk factors. Methods 0.9% sodium chloride （1 ml · kg^-1 · h^-1 ） was administered 6 hours before and 12 hours after contrast media administration for 195 elderly patients, and the dose of sodium chloride was half when the patients were suffering from severe congestive heart failure. The levels of serum creatinine （Scr） and cystatin C were measured 3 days before and on the 2nd, 5th day after the administration of contrast, respectively, Results （1） The incidence of CIN was 8.7% （17/195）. The renal function of 11 cases recovered to baseline level 3 months after the use of contrast, 2 cases had transformation to chronic renal failure but without undergoing maintenance hemodialysis, and 3 cases were dependent on maintenance hemodialysis, while 1 case developed multiple organ dysfunction until death. （2） There was no significant difference between pre-and post-contrast administration in the level of cystatin C （t=0.137, P= 0.891）. But the concentration of Scr was reduced significantly on the 2nd day compared with the baseline （t=4.776, P=0.000）. Both the cystatin C and Scr recovered to the baseline on the 5th day. （3） There were no significant differences between the CIN and non-CIN group in gender, the dose of contrast, the baseline Scr, and the proportion of coronary heart disease. But there were significant differences in age, the baseline serum cystatin C, the proportions of diabetes mellitus, hypertension and congestive heart failure. （4） The clinical risk factors of CIN were the baseline Scr （OR = 1. 039）, the baseline serum cystatin C （OR = 6. 654）, diabetes mellitus （OR=8. 104） and congestive heart failure （OR= 9. 597） according to the analysis of logislic regression. Conclusions With the hydration and the use of low-osmolar nonionic contrast, it is safe to receive contrast examination for the elderly patients. The baseline serum levels of Scrand cystatin C, diabetes mellitus and congestive heart failure are the clinical risk factors of CIN. Compared with Scr, serum evstatin C is the more powerful predictor for the development of CIN.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2009年第11期893-896,共4页
Chinese Journal of Geriatrics
关键词
造影剂
肾病
冠状血管造影术
Contrastmedia
Nephrosis
Coronary angiography
