Albert S G, Shapiro M J, Brown W W, Goodgold H, Zuckerman D, Durham R, Kern M, Fletcher J, Wolverson M, Plummer E S
Department of Internal Medicine, St. Louis University School of Medicine, MO 63104.
Invest Radiol. 1994 Jun;29(6):618-23. doi: 10.1097/00004424-199406000-00004.
This study was devised to develop a method of measuring the acute effects of radiocontrast media on renal function and assessing the relationship of the dose of radiocontrast media infused with the incidence of radiocontrast-induced renal failure. In addition, the drug adenosine phosphate-magnesium chloride (ATP-MgCl2) was evaluated as a renoprotective agent.
Eighteen patients with pre-existing renal impairment, (serum creatinine greater than 133 mumol/L) were randomized to receive a continuous infusion of ATP-MgCl2 or placebo before and during a radiocontrast procedure. Subjects were monitored with daily serum creatinine and with radionuclide renal clearance studies at baseline, during, and 24 hours after the radiocontrast procedure.
There was an initial deterioration in renal clearance in the entire study group (from 44.2 +/- 4.6 to 32.6 +/- 3.9 mL/min, P = .001) which was independent of the dose of radiocontrast infused. There was a persistent deterioration in renal clearance only in those who received greater than 135 mL of contrast media (from 48.6 +/- 7.8 to 37.1 +/- 3.9 mL/min, P = .05). There also was an increase in serum creatinine that persisted only in those subjects who received greater than 135 mL of contrast media (230 +/- 27 to 283 +/- 44 mumol/L, P = .01).
Persistent deterioration in renal function after radiocontrast administration appears to be dose-dependent and is not prevented by the use of ATP-MgCl2. Radionuclide techniques are useful in monitoring acute changes in renal function during radiocontrast procedures and may be of value in assessing renal impairment in future intervention studies.
本研究旨在开发一种测量放射性造影剂对肾功能急性影响的方法，并评估注入的放射性造影剂剂量与放射性造影剂诱发肾衰竭发生率之间的关系。此外，还评估了药物三磷酸腺苷 - 氯化镁（ATP - MgCl2）作为一种肾脏保护剂的作用。
18例已有肾功能损害（血清肌酐大于133μmol/L）的患者被随机分组，在放射性造影检查前及检查过程中接受ATP - MgCl2或安慰剂的持续输注。在基线、造影检查期间及检查后24小时，通过每日检测血清肌酐和放射性核素肾清除率研究对受试者进行监测。
整个研究组的肾清除率最初出现恶化（从44.2±4.6降至32.6±3.9 mL/min，P = 0.001），这与注入的放射性造影剂剂量无关。仅在接受超过135 mL造影剂的患者中，肾清除率持续恶化（从48.6±7.8降至37.1±3.9 mL/min，P = 0.05）。同样，血清肌酐升高也仅出现在接受超过135 mL造影剂的患者中（从230±27升至283±44μmol/L，P = 0.01）。
放射性造影剂给药后肾功能的持续恶化似乎呈剂量依赖性，且使用ATP - MgCl2并不能预防。放射性核素技术有助于监测放射性造影检查过程中肾功能的急性变化，在未来的干预研究中评估肾功能损害可能具有价值。
