目的探讨冠状动脉介入诊疗中不同剂量非离子型对比剂对肾功能的影响。方法选择行冠状动脉介入诊疗术(冠状动脉造影和/或冠状动脉支架植入术)的患者500例,其中男性280例,女性220例;年龄53～78岁,平均年龄65.0岁。单纯冠状动脉造影280例,冠状动脉造影+冠状动脉支架植入术220例。根据使用非离子型对比剂的剂量随机分为3组:低剂量组(<100 mL)180例,其中男性100例,女性80例,平均年龄60.2岁;中剂量组(100～200 mL)200例,男性110例,女性90例,平均年龄65.6岁;高剂量组(>200 mL)120例,男性70例,女性50例,平均年龄66.9岁。分别检测各组对比剂应用前及应用后8、12、24、48、72 h反映肾功能情况的血清肌酐(SCr)、胱抑素C(Cys C),比较每组内和组间不同时间段的SCr、Cys C。结果低剂量组中,SCr仅在对比剂应用后48 h升高,而Cys C仅在对比剂应用后24 h升高,且差异具有统计学意义(P<0.05),其他时段均与基线水平差异无统计学意义。与低剂量组相比,中剂量组血SCr、Cys C在各个时间段升高幅度明显增加(P<0.05),而高剂量组比中剂量组SCr、Cys C在各个时间段进一步升高(P<0.05),并且随着对比剂应用剂量的增加,如中剂量组和高剂量组其SCr、Cys C升高的程度均明显提高,差异具有统计学意义(P<0.05),且恢复速度明显变慢,部分患者对比剂应用72 h后仍未恢复到基线水平,并且较基线水平明显升高(P<0.05)。结论在冠状动脉介入诊疗中,应用非离子型对比剂对肾功能的损害与对比剂剂量明显相关,低剂量(<100 mL)对肾功能影响小且恢复快,而中剂量(100～200 mL)和高剂量(>200 mL)随着剂量的增加其对肾功能的影响越大,且恢复越慢,部分患者由对比剂造成的肾功能损害在一定时间内持续存在。 Objective To investigate the effects of different doses of non-ionic contrast medium on renal function during coronary intervention. Methods A total of 500 patients undergoing PCI (coronary angiography and / or coronary stenting) were enrolled in this study. Among them, 280 were male and 220 were female. The mean age was 65.0 years. Simple coronary angiography in 280 cases, coronary angiography + coronary stent implantation in 220 cases. According to the dosage of non-ionic contrast agent, the patients were randomly divided into three groups: low dose group (<100 mL) 180 cases, including 100 males and 80 females, with an average age of 60.2 years; Cases, 110 males and 90 females, mean age 65.6 years; 120 cases of high dose group (> 200 mL), 70 males and 50 females, mean age 66.9 years. The levels of serum creatinine (SCr) and cystatin C (Cys C) were measured before and 8, 12, 24, 48, 72 hours after the administration of contrast agent in each group. Section of SCr, Cys C. Results In the low-dose group, SCr increased only 48 h after the contrast agent application, while Cys C increased only 24 h after the contrast agent application. The difference was statistically significant (P <0.05) The difference was not statistically significant. Compared with the low dose group, the SCr and Cys C levels in the middle dose group increased significantly at all time points (P <0.05), while the SCr and Cys C levels in the high dose group were further increased at various time points (P <0.05). And with the increase of dose of contrast agent, the increase of SCr and Cys C in middle dose group and high dose group were significantly increased, the difference was statistically significant (P <0.05), and the recovery rate Obviously slowed down. Some patients did not return to the baseline level after 72 hours of application of contrast medium and were significantly higher than the baseline level (P <0.05). Conclusions In the interventional treatment of coronary artery, the damage of renal function by nonionic contrast agent is obviously related to the dose of contrast agent. Low dose (<100 mL) has little effect on renal function and fast recovery, while medium dose (100 ~ 200 mL ) And high dose (> 200 mL) with the dose increased its greater impact on renal function, and the slower the recovery, some patients with renal damage caused by contrast agents persist for a certain period of time.