CAJ | 학술논문

目的探讨不同剂量碘帕醇对糖尿病患者肾功能的影响.方法入选148例行冠状动脉造影或经皮冠状动脉介入(PCI)治疗的糖尿病患者,根据对比剂的使用量,分为低剂量组(＜100 ml),中剂量组(100～200 ml)和高剂量组(＞200 ml).术前及术后72 h检测患者血清肌酐浓度;分析不同剂量对比剂对血清肌酐水平、估测肌酐清除率(eGFR)的影响及年龄、性别和eGFR、低密度脂蛋白、血压水平等因素对对比剂肾病(CIN)发生率的影响.结果术后各组间的肌酐浓度、eGFR差异无统计学意义(P＞0.05);术后肌酐水平在中、高剂量组明显高于术前[分别(96.4±21.8)μmol/L比(87.5±21.8)μmol/L,(100.8±23.9)μmol/L比(88.1±19.9)μmol/L,均P＜0.05],各组eGFR同术前相比差异无统计学意义(P＞0.05).低eGFR及女性患者CIN 发生率明显高于eGFR正常和男性患者(均P＜0.05).结论在特定的糖尿病患者中使用较大剂量的碘帕醇是安全的.
목적 탐토불동제량전파순대당뇨병환자신공능적영향.방법 입선148례행관상동맥조영혹경피관상동맥개입(PCI)치료적당뇨병환자,근거대비제적사용량,분위저제량조(＜100 ml),중제량조(100～200 ml)화고제량조(＞200 ml).술전급술후72 h검측환자혈청기항농도;분석불동제량대비제대혈청기항수평、고측기항청제솔(eGFR)적영향급년령、성별화eGFR、저밀도지단백、혈압수평등인소대대비제신병(CIN)발생솔적영향.결과 술후각조간적기항농도、eGFR차이무통계학의의(P＞0.05);술후기항수평재중、고제량조명현고우술전[분별(96.4±21.8)μmol/L비(87.5±21.8)μmol/L,(100.8±23.9)μmol/L비(88.1±19.9)μmol/L,균P＜0.05],각조eGFR동술전상비차이무통계학의의(P＞0.05).저eGFR급녀성환자CIN 발생솔명현고우eGFR정상화남성환자(균P＜0.05).결론 재특정적당뇨병환자중사용교대제량적전파순시안전적.
Objective To determine the effects of the volume of contrast media and risk factors on kidney function in diabetic patients undergoing elective cardiac catheterization or percutaneous coronary intervention (PCI). Methods Totally 148 consecutive diabetic patients undergoing elective cardiac catheterization or PCI were divided into three groups; low dose (＜100 ml), middle dose (100-200 ml) and high dose group (＞200 ml). Serum creatinine and estimated glomerular filtration rate(eGFR) at baseline and after 72 hours of the procedure were measured. The incidence of CIN and the effect of variables on rate of CIN were evaluated. Results There were no significant differences on serum creatinine level and eGFR among groups after cardiac catheterization or PCI. Compared with the preoperative, the levels of serum creatinine in middle dose and high dose group were higher after the procedure [(96.4±21.8)μmol/L vs (87. 5 ±21. 8)μmol/L, (100. 8 ±23. 9) μmol/L vs (88.1 ± 19.9) μmol/L, P＜ 0.05]. The increase of serum creatinine in high dose group were significantly higher than in low dose and middle dose groups. There was no significant difference on eGFR and on the incidence of CIN among groups after cardiac catheterization or PCI. CIN developed more frequently after PCI in female or lower eGFR patients. Conclusion It is safe for some diabetic patients to use large dose of contrast media.