杜梦阳,姜琳,唐晓芳,高展,袁晋青

• 1:国家心血管病中心北京协和医学院中国医学科学院阜外医院心内科

摘要(Abstract)：

目的比较碘克沙醇与碘海醇/碘普罗胺对经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)发生率及其远期预后的影响。方法选择2013年1-12月在中国医学科学院阜外医院接受PCI术的符合标准的6167例患者作为研究对象。根据所用对比剂的类型,将患者分为碘克沙醇组(1709例)、碘海醇组(1284例)和碘普罗胺组(3174例)。通过Cox回归分析研究碘克沙醇与碘海醇、碘普罗胺与CIN发生率、PCI术后2年全因死亡率的关系。结果碘克沙醇组、碘海醇组和碘普罗胺组的CIN发生率分别为1.9%、3.5%和1.6%。logistic多因素分析表明,与碘克沙醇相比,碘海醇的使用显著增加了CIN的发生率(OR 2.114,95%CI 1.104～3.714,P=0.009),而与碘克沙醇相比,碘普罗胺没有增加CIN的发生率(OR 1.128,95%CI 0.665～1.912,P=0.656)。Cox多因素回归分析显示,与碘克沙醇相比,碘海醇和碘普罗胺的使用均不会影响患者的2年全因死亡率(HR 1.914,95%CI 0.920～3.983,P=0.083;HR 1.069,95%CI 0.593～1.927,P=0.825)。结论与碘克沙醇相比,碘海醇对比剂会显著增加PCI术后CIN的发生率,而碘普罗胺不会。但是碘海醇和碘普罗胺与碘克沙醇相比均对2年全因死亡率没有显著影响。

关键词(KeyWords)： 碘克沙醇;碘海醇;碘普罗胺;等渗对比剂;低渗对比剂

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划项目（2016YFC1301300）

作者(Author): 杜梦阳,姜琳,唐晓芳,高展,袁晋青

参考文献(References)：

• [1] Scharnweber T, Alhilali L, Fakhran S. Contrast-induced acute kidney injury:pathophysiology, manifestations, prevention, and management.Magn Reson Imaging Clin N Am, 2017, 25(4):743-753.
• [2] McCullough PA, Choi JP, Feghali GA, et al. Contrast-induced acute kidney injury. J Am Coll Cardiol, 2016, 68(13):1465-1473.
• [3] Solomon R. The role of osmolality in the incidence of contrastinduced nephropathy:a systematic review of angiographic contrast media in high risk patients. Kidney Int, 2005, 68(5):2256-2263.
• [4] Bucher AM, De Cecco CN, Schoepf UJ, et al. Is contrast medium osmolality a causal factor for contrast-induced nephropathy? Biomed Res Int, 2014, 2014:931413.
• [5] Smith SC, Dove JT, Jacobs AK, et al. ACC/AHA guidelines for percutaneous coronary intervention(revision of the 1993 PTCA guidelines)-executive summary:a report of the American College of Cardiology/American Heart Association task force on practice guidelines(committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty)endorsed by the society for cardiac angiography and interventions. Circulation, 2001, 103(24):3019-3041.
• [6] Khwaja A. KDIGO clinical practice guideline for acute kidney injury.Nephron Clin Pract,2012, 120(4):c179-c184.
• [7] F?hling M, Seeliger E, Patzak A, et al. Understanding and preventing contrast-induced acute kidney injury. Nat Rev Nephrol,2017, 13(3):169-180.
• [8] From AM, Al Badarin FJ, McDonald FS,et al. Iodixanol versus low-osmolar contrast media for prevention of contrast induced nephropathy:meta-analysis of randomized, controlled trials.Circ Cardiovasc Interv, 2010, 3(4):351-358.
• [9] McCullough PA, Bertrand ME, Brinker JA, et al. A meta-analysis of the renal saf ety of isosmolar iodixanol compared with low-osmolar contrast media. Am Coll Cardiol, 2006, 48(4):692-699.
• [10] Aspelin P, Aubry P, Fransson SG, et al. Nephrotoxic effects in highrisk patients undergoing angiography. N Engl J Med, 2003, 348(6):491-499.
• [11] Mruk B. Renal safety of iodinated contrast media depending on their osmolarity-current outlooks. Pol J Radiol, 2016, 81:157-165.
• [12] Zhang J, Jiang Y, Rui Q, et al. Iodixanol versus iopromide in patients with renal insu fficiency undergoing coronary angiography with or without PCI. Medicine, 2018, 97(18):e0617.
• [13]赵健斌，吴登轩，陈世群，等.对比剂诱导急性肾损伤的机制与预防策略.国际心血管病杂志，2016, 43(5):280-282.