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《生物医学工程研究》[ISSN:1006-6977/CN:61-1281/TN]

期数:

2011年04期

页码:

244-247

栏目:

论著

出版日期:

2011-12-30

文章信息/Info

Title:

The Clinical Research of Contrast Agent-induced Acute Renal Injury with Treatment of Continuous Blood Purification

作者:

孟建中¹△; 荣鹏¹; 周春华²; 王素霞¹; 刘文渊¹; 景颖¹; 贾凤玉¹; 葛彦明¹; 岳冀¹

1.中国人民解放军济南军区总医院，济南 250031；2.中国人民解放军海军总医院，北京 100023

Author(s):

RONG Peng¹; MENG Jianzhong¹△; ZHOU Chunhua²; WANG Suxia¹;  LIU Wenyuan¹; JING Ying¹; JIA Fengyu¹; GE Yanming¹; YUE Ji¹

1.The General Hospital of Jinan Military Command，Jinan 250031；2.The General Hospital of PLA Navy，Beijing 100023

关键词:

对比剂; 急性肾损伤; 连续性血液净化; 高敏C反应蛋白

Keywords:

Contrast agent;  Acute kidney injury;  Continuous blood purification;  High-sensitivity C-reactive protein

分类号:

R318

DOI:

-

文献标识码:

A

摘要:

研究连续性血液净化（CBP）救治对比剂急性肾损伤（CI-AKI）的临床特点。 选取2003年5月至2010年5月间救治的32例CI-AKI患者，分析发病规律，检测造影前、后及CBP救治前、后其血肌酐（Cr）、尿酸（UA）、高敏C反应蛋白（hs- CRP）等生化指标的动态变化，观察患者28 d的病死率。结果表明（1）发病规律：17例（53.13%）冠心病并存糖尿病患者在接受心导管治疗后发生CI-AKI，其中13例（40.62%）同时服用双胍类降糖药。（2）临床特点：造影术后24 h, 患者尿酸及hs- CRP水平明显增高，在48 h达高峰；而血肌酐水平则在造影术后48 h增高，在术后72 h达高峰。经相关性分析发现，血尿酸水平与hs-CRP含量变化呈现正相关(ｒ=0.66,Ｐ＜0.05)。（3）转归： 29例（90.62%）患者在CBP治疗48h脱离少尿期，人/肾均得以生存。2例（6.25%）因肾脏死亡，现依赖维持性透析生存。死亡1例（3.12%），死亡原因为PCI术后12 d，发生恶性心律失常。PCI术前，糖尿病患者服用双胍类降糖药是CI-AKI的独立危险因素。血尿酸及hs-CRP水平变化是反映CI-AKI细胞损伤的敏感指标之一。CBP能够改善肾脏灌注，加快对比剂和尿酸的排泄，降低肾小管上皮细胞的氧化应激反应，保护肾功能。

Abstract:

To study the clinical features of Contrast agent-induced acute renal injury(CI-AKI) with treatment of continuous blood purification (CBP). 32 cases of CI-AKI patients we treated from May 2003 to May 2010 were selected. We analyzed the pathogenesis, detected the continuous changes of the levels of serum creatinine (Scr), uric acid (UA), high-sensitivity C-reactive protein (hs-CRP) and other biochemical indicators before and after imaging and before and after CBP treatment, observed the mortality of CI-AKI patients in 28 days.The law of the incidence: 17 cases with coronary heart disease with diabetes suffered from CI-AKI after receiving treatment in the cardiac catheterization. Among them, 13 cases (40.62%) while taking biguanide hypoglycemic agents.Clinical features: At 24h after angiography, uric acid and hs-CRP levels were significantly increased, and peaked at 48h. The Scr level increased at 48h after angiography, and reached a peak at 72h after surgery. The correlation analysis showed that serum uric acid levels and changes in hs-CRP levels showed a positive correlation (r=0.66,P＜0.05). Outcome:29 cases(90.62%) patients out of oliguria after 48h in CBP treatment, people/kidney were to survive. 2 cases (6.25%) due to renal failure, survival was dependent on maintenance dialysis. 1 patient died (3.12%) of malignant arrhythmia after PCI, 12 d. Biguanide hypoglycemic is an independent risk factor in diabetic patients suffering from CI-AKI after PCI. The changes of Serum uric acid and hs-CRP levels are sensitive indicator reflect cell damage in CI-AKI.CBP can improve renal perfusion, accelerate the excretion of uric acid and contrast agent, reduce the effect of oxidative stress in the renal tubular epithelial cells, protect renal function.

参考文献/References

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备注/Memo

备注/Memo:

收稿日期：2011-10-20 △通信作者Email:mjz90@yahoo.com.cn

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更新日期/Last Update: 2011-12-30