Cavaliere G, Arrigo G, D'Amico G, Bernasconi P, Schiavina G, Dellafiore L, Vergnaghi D
Nephron. 1987;46(2):128-33. doi: 10.1159/000184327.
Nephrotoxicity of intravenous contrast media is more frequent and striking in patients with risk factors, the major one being preexisting chronic renal insufficiency. New nonionic low-osmolal contrast media allegedly have less nephrotoxicity than the traditional ionic high-osmolal ones. This was tested for two contrast media in a group of 18 patients with stable chronic renal insufficiency. The urinary excretion of two brush-border enzymes (alanine aminopeptidase, AAP, and gamma-glutamyl transpeptidase, gamma-GT) and of a lysosomal enzyme (N-acetyl-beta glucosaminidase, NAG), functional markers of tubular injury, were measured before and after intravenous urography with an ionic high-osmolal radiocontrast medium, meglumine sodium diatrizoate, or with a non ionic low-osmolal one, iopamidol. Urinary NAG excretion did not change significantly after administration of either contrast media. Urinary AAP and gamma-GT excretion increased significantly (p less than 0.01) after diatrizoate. After iopamidol, only gamma-GT excretion increased significantly (p less than 0.05). Our data suggest that the nonionic low-osmolal radiocontrast medium iopamidol is less toxic to tubules than the ionic high-osmolal medium diatrizoate and that the brush-border enzymes AAP and gamma-GT are sensitive markers for this toxicity.
静脉造影剂的肾毒性在有危险因素的患者中更为常见且显著，其中主要危险因素是已存在的慢性肾功能不全。据称，新型非离子低渗造影剂的肾毒性低于传统的离子高渗造影剂。在一组18例稳定的慢性肾功能不全患者中，对两种造影剂进行了此项测试。在用离子高渗造影剂泛影葡胺钠或非离子低渗造影剂碘帕醇进行静脉尿路造影之前和之后，测量了两种刷状缘酶（丙氨酸氨基肽酶，AAP，和γ-谷氨酰转肽酶，γ-GT）以及一种溶酶体酶（N-乙酰-β-氨基葡萄糖苷酶，NAG）的尿排泄情况；这些酶是肾小管损伤的功能标志物。给予任何一种造影剂后，尿NAG排泄均无显著变化。给予泛影葡胺后，尿AAP和γ-GT排泄显著增加（p<0.01）。给予碘帕醇后，仅γ-GT排泄显著增加（p<0.05）。我们的数据表明，非离子低渗造影剂碘帕醇对肾小管的毒性低于离子高渗造影剂泛影葡胺，并且刷状缘酶AAP和γ-GT是这种毒性的敏感标志物。
