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目的 :研究慢性肾功能不全患者造影剂相关性肾病 (CAN)的发生率和临床特征 ,探讨内皮素 (ET1)和一氧化氮 (NO)在CAN中的作用。 方法 :观察 13例原有慢性肾功能不全患者造影前后血清肌酐 (SCr)及尿ET1和NO水平变化。CAN诊断标准为造影后SCr较基础值增加 2 5 %和 88 4μmol/L。 结果 :使用造影剂后SCr均升高较基础值净增 90 6～ 736 μmol/L(平均 2 5 4 6 μmol/L)。CAN的发生率为 6 1 5 %。SCr上升峰值时间为第 3～ 7天(平均 5天 ) ;恢复至基础水平的时间为第 10～ 45天 (平均 2 0天 ) ,6例患者SCr未恢复至基础水平。造影后尿ET1水平显著增高 ,NO水平下降 ,ET1/NO水平显著增高 (P均小于 0 0 1)。 结论 :慢性肾功能不全患者使用造影剂后肾衰均加重 ,ET1和NO的失衡可能在造影剂肾病的发病中起重要作用。
Objective: To investigate the incidence and clinical features of contrast-induced nephropathy (CAN) in patients with chronic renal failure and to explore the role of endothelin (ET1) and nitric oxide (NO) in CAN. Methods: The changes of serum creatinine (SCr) and urinary ET1 and NO levels in 13 patients with chronic renal failure before and after angiography were observed. CAN diagnostic criteria for post-contrast SCr increased 25% compared with the base value and 88 4μmol / L. RESULTS: After administration of contrast agent, SCr increased by 906-736 μmol / L (average, 2 546 μmol / L) compared with baseline. The incidence of CAN was 61.5%. The peak SCr rise time was from day 3 to day 7 (average 5 days); the time to basal level was from day 10 to day 45 (average 20 days); SCr did not recover to basal levels in 6 patients. After angiography, the level of ET1 increased significantly, the level of NO decreased and the level of ET1 / NO increased significantly (P <0.01). CONCLUSIONS: Renal failure is worsened in patients with chronic renal failure after contrast media administration. The imbalance between ET1 and NO may play an important role in the pathogenesis of contrast-induced nephropathy.