静脉注射对比剂增强CT中，等渗与低渗碘对比剂对肾功能的影响

Iso-osmolality versus low-osmolality iodinated contrast medium at intravenous contrast-enhanced CT: effect on kidney function.

作者信息

Nguyen Shaun A, Suranyi Pal, Ravenel James G, Randall Patrick K, Romano Peter B, Strom Kimberly A, Costello Philip, Schoepf U Joseph

机构信息

Department of Radiology, Medical University of South Carolina, PO Box 250322, 169 Ashley Ave, Charleston, SC 29425, USA.

出版信息

Radiology. 2008 Jul;248(1):97-105. doi: 10.1148/radiol.2481071484. Epub 2008 May 15.

DOI:10.1148/radiol.2481071484

PMID:18483232

Abstract

PURPOSE

To determine the effects of iso-osmolality contrast medium compared with a low-osmolality agent on renal function (serum creatinine [SCr] and glomerular filtration rate [GFR]) in high-risk patients undergoing intravenous contrast material-enhanced CT.

MATERIALS AND METHODS

This HIPAA-compliant study was IRB-approved; formal consent was obtained. One hundred seventeen patients (83 men, 34 women; mean age, 64.3 years; range, 18-86 years) with decreased renal function underwent contrast-enhanced CT with either iso-osmolality iodixanol (n = 61) or low-osmolality iopromide (n = 56). Outcome measures were of SCr increase or GFR decrease for 3 days after CT, a SCr increase (of >or=0.5 mg/dL [44.2 micromol/L, 25%] or >or=1.0 mg/dL [88.4 micromol/L, 50%]), a GFR reduction (of >or=5 mL/min), and patient outcome at 30- and 90-day follow-up.

RESULTS

Iodixanol decreased SCr (mean +/- standard deviation) from 1.77 mg/dL +/- 0.24 (156.47 micromol/L +/- 21.22) at baseline to 1.65 mg/dL +/- 0.35 (145.86 micromol/L +/- 30.94, P = .046) at day 1, 1.73 mg/dL +/- 0.53 (152.93 micromol/L +/- 46.85, not significant) at day 2, and 1.73 mg/dL +/- 0.55 (152.93 micromol/L +/- 48.62, not significant) at day 3 (not significant). Iopromide increased SCr from 1.75 mg/dL +/- 0.32 (154.7 micromol/L +/- 28.29) at baseline to 1.8 mg/dL +/- 0.42 (159.12 micromol/L +/- 15.59) at day 1, 1.77 mg/dL +/- 0.49 (156.47 micromol/L +/- 43.32) at day 2, and 1.77 mg/dL +/- 0.62 (156.47 micromol/L +/- 54.81) at day 3 (not significant). Iodixanol increased and iopromide decreased GFR on all 3 days after CT (not significant). Fewer patients in the iodixanol group (8.5%) than in the iopromide group (27.8%) had SCr increase 0.5 mg/dL or higher (>or=25%, P = .012). Two patients in each group had SCr increase of 1.0 mg/dL or more (not significant). More patients in the iopromide group (42.3%) than in the iodoxanol group (24.1%) had a GFR reduction of 5 mL/min or higher (P = .0426). No patient had a contrast material-related adverse event at 30- or 90-day follow-up.

CONCLUSION

Intravenous contrast material application in high-risk patients is unlikely to be associated with permanent adverse outcomes. SCr levels after contrast material administration are lower in iodixanol than iopromide groups.

摘要

目的

确定等渗对比剂与低渗对比剂相比，对接受静脉造影剂增强CT的高危患者肾功能（血清肌酐[SCr]和肾小球滤过率[GFR]）的影响。

材料与方法

本研究符合HIPAA规定，经机构审查委员会（IRB）批准；获得了正式同意书。117例肾功能减退患者（83例男性，34例女性；平均年龄64.3岁；范围18 - 86岁）接受了增强CT检查，其中61例使用等渗的碘克沙醇，56例使用低渗的碘普罗胺。观察指标为CT检查后3天内SCr升高或GFR降低情况、SCr升高（≥0.5mg/dL[44.2μmol/L，25%]或≥1.0mg/dL[88.4μmol/L，50%]）、GFR降低（≥5mL/min）以及30天和90天随访时的患者结局。

结果

碘克沙醇使SCr（均值±标准差）从基线时的1.77mg/dL±0.24（156.47μmol/L±21.22）在第1天降至1.65mg/dL±0.35（145.86μmol/L±30.94，P = 0.046），第2天为1.73mg/dL±0.53（152.93μmol/L±46.85，无显著差异），第3天为1.73mg/dL±0.55（152.93μmol/L±48.62，无显著差异）（无显著差异）。碘普罗胺使SCr从基线时的1.75mg/dL±0.32（154.7μmol/L±28.29）在第1天升至1.8mg/dL±0.42（159.12μmol/L±15.59），第2天为1.77mg/dL±0.49（x156.47μmol/L±43.32），第3天为1.77mg/dL±0.62（156.47μmol/L±54.81）（无显著差异）。CT检查后的所有3天里，碘克沙醇使GFR升高，碘普罗胺使GFR降低（无显著差异）。碘克沙醇组SCr升高≥0.5mg/dL的患者（8.5%）少于碘普罗胺组（27.8%）（≥25%，P = 0.012）。每组各有2例患者SCr升高≥1.0mg/dL（无显著差异）。碘普罗胺组GFR降低≥5mL/min的患者（42.3%）多于碘克沙醇组（24.1%）（P = 0.0426）。在30天或90天随访时，无患者发生与造影剂相关的不良事件。