Dittrich S, Kurschat K, Dähnert I, Vogel M, Müller C, Lange P E
Deutsches Herzzentrum Berlin, Abteilung Angeborene Herzfehler/Kinderkardiologie, Germany.
Cardiol Young. 2000 Jan;10(1):8-14. doi: 10.1017/s1047951100006314.
Chronic cyanosis with its associated rheologic changes is a known risk factor for glomerular nephropathy. Therefore, contrast-induced nephrotoxicity should be an important consideration for angiographers comparable to diabetics. On the other hand, progressions in diagnostic and interventional techniques have led to expanded indications and a more widespread use of x-ray contrast agents. The aim of this study was to investigate the risk of contrast-induced nephropathy in the small group of patients with cyanotic heart disease prior to surgical repair.
We investigated 23 cyanotic patients with an oxygen saturation of 82 (50-92)%, age 25 (5-63) years, and 13 control subjects with atrial septal defect, age 37 (20-66) years. Blood viscosity was measured before and after cardiac catherization. Renal damage was evaluated by selective analysis of urinary proteins and enzymes.
Before cardiac catheterization, 48% of the cyanotic patients had a moderate glomerulopathy. Cardiac catherization was performed with 3.0 (1.2-6.8) mls/kg non ionic contrast medium. Only one of the 23 patients (4.3%) with normal urinary analysis before cardiac catheterization showed renal damage, which involved tubular and glomerular function. Elevated blood viscosity in cyanotic patients was slightly reduced by the contrast. None of the acyanotic controls had contrast-induced nephropathy.
The use of non-ionic contrast medium does not worsen cyanotic glomerulopathy. This finding may be due to the reduction of blood viscosity by the application of the contrast medium. The finding of contrast-induced nephropathy in one patient underlines the importance of monitoring renal function after cardiac catheterization.
慢性发绀及其相关的血液流变学改变是已知的肾小球肾病危险因素。因此，对比剂诱导的肾毒性对于血管造影医师而言应是一个与糖尿病患者相当重要的考虑因素。另一方面，诊断和介入技术的进步导致了X线对比剂的适应证扩大和更广泛应用。本研究的目的是调查在手术修复前一小部分患有紫绀型心脏病患者中对比剂诱导的肾病风险。
我们调查了23例氧饱和度为82（50 - 92）%、年龄为25（5 - 63）岁的发绀患者，以及13例年龄为37（20 - 66）岁、患有房间隔缺损的对照受试者。在心脏导管插入术前和术后测量血液粘度。通过对尿蛋白和酶的选择性分析评估肾损伤。
在心脏导管插入术前，48%的发绀患者患有中度肾小球病。使用3.0（1.2 - 6.8）ml/kg非离子型对比剂进行心脏导管插入术。在心脏导管插入术前尿分析正常的23例患者中，只有1例（4.3%）出现了涉及肾小管和肾小球功能的肾损伤。对比剂使发绀患者升高的血液粘度略有降低。无青紫对照组发生对比剂诱导的肾病。
使用非离子型对比剂不会加重发绀型肾小球病。这一发现可能是由于应用对比剂降低了血液粘度。1例患者出现对比剂诱导的肾病这一发现强调了心脏导管插入术后监测肾功能的重要性。
