对比剂肾病：肾动脉狭窄中静脉CT血管造影与动脉数字减影血管造影的比较：一项前瞻性随机试验

Contrast media nephropathy: intravenous CT angiography versus intraarterial digital subtraction angiography in renal artery stenosis: a prospective randomized trial.

作者信息

Lufft Volkmar, Hoogestraat-Lufft Linda, Fels Lüder M, Egbeyong-Baiyee Daniel, Tusch Günter, Galanski Michael, Olbricht Christoph J

机构信息

Abteilung Nephrologie, Abteilung Diagnostische Radiologie, Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Germany.

出版信息

Am J Kidney Dis. 2002 Aug;40(2):236-42. doi: 10.1053/ajkd.2002.34501.

DOI:10.1053/ajkd.2002.34501

PMID:12148095

Abstract

BACKGROUND

Spiral computed tomographic angiography (CTA) is a noninvasive method to diagnose renal artery stenosis (RAS). In digital subtraction angiography (DSA), contrast media (CM) is injected directly into the renal artery; in CTA, a greater amount of CM is injected intravenously, potentially leading to an increased incidence of CM nephropathy.

METHODS

We investigated 80 patients with suspected RAS randomized to either CTA or DSA prospectively. The following parameters were determined: serum creatinine level and single-shot inulin clearance for evaluation of renal function and urine alpha1-microglobulin and beta-N-acetyl-glucoseaminidase (beta-NAG) as markers for tubular toxicity. Data from 16 patients undergoing angioplasty in the same session were excluded.

RESULTS

In the CTA and DSA groups, 163 +/- 13 and 104 +/- 56 mL of CM (mean +/- SD; P < 0.0001) were administered, respectively. Mean serum creatinine levels increased from 1.78 +/- 1.61 to 1.92 +/-1.73 mg/dL (157 +/- 142 to 170 +/- 153 micromol/L; P = 0.00001) in the CTA group and from 1.52 +/- 1.23 to 1.60 +/- 1.28 mg/dL (134 +/- 109 to 141 +/- 113 micromol/L; P = 0.01) in the DSA group. Mean inulin clearance decreased from 63 +/- 28 to 58 +/- 23 mL/min (P = 0.01) and 65 +/- 26 to 62 +/- 26 mL/min (P < 0.01), median beta-NAG levels increased from 4.6 to 6.0 U/g creatinine (P = not significant) and 2.5 to 8.0 U/g creatinine (P < 0.001), and median alpha1-microglobulin levels increased from 13 to 17 microg/g creatinine (P < 0.025) and 11 to 21 microg/g creatinine (P = not significant) in the CTA and DSA groups, respectively. CM nephropathy occurred in 3 of 33 patients in the CTA group and 2 of 31 patients in the DSA group. The increase in creatinine level was reversible in all patients within 7 days.

CONCLUSION

On this study, CTA performed for the detection of RAS is not associated with an increased risk for CM nephropathy compared with intraarterial DSA despite a greater dose of CM.

摘要

背景

螺旋计算机断层血管造影（CTA）是诊断肾动脉狭窄（RAS）的一种非侵入性方法。在数字减影血管造影（DSA）中，造影剂（CM）直接注入肾动脉；而在CTA中，更多的CM经静脉注射，这可能导致CM肾病的发生率增加。

方法

我们前瞻性地研究了80例疑似RAS的患者，将其随机分为CTA组或DSA组。测定了以下参数：血清肌酐水平和单次菊粉清除率以评估肾功能，尿α1-微球蛋白和β-N-乙酰氨基葡萄糖苷酶（β-NAG）作为肾小管毒性的标志物。同一时段接受血管成形术的16例患者的数据被排除。

结果

CTA组和DSA组分别给予了163±13和104±56 mL的CM（均值±标准差；P<0.0001）。CTA组平均血清肌酐水平从1.78±1.61 mg/dL（157±142 μmol/L）升至1.92±1.73 mg/dL（170±153 μmol/L；P = 0.00001），DSA组从1.52±1.23 mg/dL（134±109 μmol/L）升至1.60±1.28 mg/dL（141±113 μmol/L；P = 0.01）。CTA组平均菊粉清除率从63±28 mL/min降至58±23 mL/min（P = 0.01），DSA组从65±26 mL/min降至62±26 mL/min（P<0.01）；CTA组和DSA组β-NAG中位数水平分别从4.6升至6.0 U/g肌酐（P无统计学意义）和从2.5升至8.0 U/g肌酐（P<0.001），α1-微球蛋白中位数水平分别从13升至17 μg/g肌酐（P<0.025）和从11升至21 μg/g肌酐（P无统计学意义）。CTA组33例患者中有3例发生CM肾病，DSA组31例患者中有2例发生。所有患者的肌酐水平升高在7天内均可逆转。