Harris K G, Smith T P, Cragg A H, Lemke J H
Department of Diagnostic Radiology, University of Iowa College of Medicine, Iowa City.
Radiology. 1991 Jun;179(3):849-52. doi: 10.1148/radiology.179.3.2028004.
Controversy exists over whether use of low-osmolality contrast agents is of any benefit in mitigating the risk of contrast material-induced nephrotoxicity (CN) in patients with impaired renal function. To test this hypothesis, 101 adult inpatients with high serum creatinine levels (range, 1.4-2.4 mg/dL [120-210 mumol/L]) undergoing contrast material-enhanced computed tomography were randomized to receive ionic or nonionic (low-osmolality) contrast agents in a uniform dose. Changes in serum creatinine level at 48 hours were measured. Seven (14%) of the 50 patients receiving ionic contrast media experienced an increase of 25% or more in serum creatinine level. Only one (2%) of the 51 patients receiving nonionic contrast agents experienced such an increase, a statistically significant difference (P less than .05). In the subset of 25 diabetic patients, the difference was of a similar magnitude. These data suggest that ionic contrast media are more likely than nonionic contrast agents to cause mild exacerbation of renal insufficiency when given intravenously. However, there were no cases of clinically important CN in the study.
对于使用低渗性造影剂是否有助于降低肾功能受损患者发生造影剂诱导的肾毒性（CN）风险，目前仍存在争议。为了验证这一假设，对101例血清肌酐水平较高（范围为1.4 - 2.4 mg/dL [120 - 210 μmol/L]）且正在接受造影剂增强计算机断层扫描的成年住院患者进行随机分组，使其接受相同剂量的离子型或非离子型（低渗性）造影剂。测量48小时时血清肌酐水平的变化。接受离子型造影剂的50例患者中有7例（14%）血清肌酐水平升高了25%或更多。接受非离子型造影剂的51例患者中只有1例（2%）出现了这种升高，差异具有统计学意义（P小于0.05）。在25例糖尿病患者亚组中，差异幅度相似。这些数据表明，静脉注射时，离子型造影剂比非离子型造影剂更有可能导致肾功能不全轻度加重。然而，该研究中没有发生具有临床意义的CN病例。
