Naito Shokichi, Tazaki Hiromi, Okamoto Tomoko, Takeuchi Kazuhiro, Kan Shinichi, Takeuchi Yasuo, Kamata Kouju
Department of Nephrology, Kitasato University School of Medicine.
Department of Diagnostic Radiology, Kitasato University School of Medicine.
J Toxicol Sci. 2017;42(3):379-384. doi: 10.2131/jts.42.379.
Although gadolinium (Gd)-based contrast media have been found to be nephrotoxic, their nephrotoxicity, and the dependence of nephrotoxicity on chelate types, have not been assessed in patients with normal or mildly diminished renal failure. This prospective, randomized study compared the nephrotoxicity of low doses of the nonionic Gd-based contrast medium gadodiamide (Omniscan®) and the ionic Gd-based contrast medium gadopentetate (Magnevist®) in patients with serum creatinine < 1.6 mg/dL. Patients aged 20 to 80 years, weighing 45 to 70 kg and with normal or < 1.6 mg/dL Serum-creatinine in the 3 months prior to undergoing magnetic resonance imaging (MRI) of brain, were enrolled. Patients were randomized to receive 0.1 mol/kg gadodiamide or gadopentetate. Serum-creatinine, serum cystatin-C, estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula, and estimated creatinine clearance rate (eCCr) using the Cockcroft-Gault formula were measured just before and 16-80 hr after MRI. Groups were compared statistically by Mann-Whitney U-tests and Wilcoxon signed-rank tests. There were no significant differences in clinical characteristics between the gadodiamide (n = 43) and gadopentetate (n = 59) groups. Serum-creatinine, eGFR and eCCr before and 16-80 hr after MRI did not differ significantly within either group or between the two groups. Serum cystatin-C was significantly higher 16-80 hr after than before MRI only in the gadodiamide group (0.79 ± 0.21 vs. 0.74 ± 0.14 mg/L, p = 0.028). The ionic contrast medium, gadopentetate, did not affect renal function during MRI, whereas the nonionic contrast medium, gadodiamide, affected renal function transiently.
尽管已发现钆（Gd）基造影剂具有肾毒性，但尚未在肾功能正常或轻度减退的患者中评估其肾毒性以及肾毒性对螯合物类型的依赖性。这项前瞻性随机研究比较了血清肌酐<1.6mg/dL的患者中低剂量非离子型Gd基造影剂钆双胺（欧乃影®）和离子型Gd基造影剂钆喷酸葡胺（马根维显®）的肾毒性。纳入年龄在20至80岁、体重45至70kg且在接受脑部磁共振成像（MRI）前3个月血清肌酐正常或<1.6mg/dL的患者。患者被随机分配接受0.1mol/kg钆双胺或钆喷酸葡胺。在MRI前及MRI后16 - 80小时测量血清肌酐、血清胱抑素C、使用肾脏病饮食改良（MDRD）公式估算的肾小球滤过率（eGFR）以及使用Cockcroft - Gault公式估算的肌酐清除率（eCCr）。通过Mann - Whitney U检验和Wilcoxon符号秩检验进行组间统计学比较。钆双胺组（n = 43）和钆喷酸葡胺组（n = 59）的临床特征无显著差异。MRI前后16 - 80小时，两组内及两组间的血清肌酐、eGFR和eCCr均无显著差异。仅钆双胺组在MRI后16 - 80小时血清胱抑素C显著高于MRI前（0.79±0.21 vs. 0.74±0.14mg/L，p = 0.028）。离子型造影剂钆喷酸葡胺在MRI期间不影响肾功能，而非离子型造影剂钆双胺会短暂影响肾功能。
