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目的造影剂肾病(Contrast media induced nephropathy,CIN)是发生于对比剂(CM)应用之后的急性肾功能损害,大约占所有获得性肾功能不全的11%。本研究目的在于观察茶碱药物是否可以减少CIN。方法 280例接受造影剂患者随机分成碳酸氢钠加氨茶碱组(n=152)和仅用碳酸氢钠组(n=128)。分别于造影剂应用前后测验血尿素氮、肌酐、肾小球滤过率(GFR)。两组患者的临床特征和造影剂应用剂量相似。结果符合CIN者14例,其中6例男性。CIN患者的平均年龄(58.64±8.96)岁,9例患者血肌酐≥1.5 mg/dl。CIN患者的造影剂用量为(196.4±116.8)ml。与非CIN(4.55±3.9)患者相比,CIN患者危险计分较高(12.00±2.90)。茶碱药物组患者CIN发生率明显低于仅用碳酸氢钠组(1.6%比7.9%;P=0.015)。茶碱组仅有2例CIN,对照组有10例,差异有统计学意义(P=0.015)。茶碱组有1例、对照组有2例出现少尿。根据CIN危险计分,低危险患者应用茶碱后CIN发生率无显著下降,中至重度危险者CIN发生率显著降低(P=0.014)。结论茶碱可以减少CIN的发生率。
Purpose Contrast media induced nephropathy (CIN) is an acute renal impairment that occurs after contrast agent (CM) administration, accounting for about 11% of all acquired renal insufficiency. The purpose of this study was to observe whether theophylline drugs can reduce CIN. Methods 280 patients undergoing contrast media were randomly divided into sodium bicarbonate plus aminophylline group (n = 152) and sodium bicarbonate alone group (n = 128). Blood urea nitrogen, creatinine and glomerular filtration rate (GFR) were measured before and after contrast agent application respectively. The clinical characteristics of both groups were similar to those of contrast media. Results CIN in line with 14 cases, of which 6 cases of men. The average age of patients with CIN (58.64 ± 8.96) years, 9 patients with serum creatinine ≥ 1.5 mg / dl. CIN patients with contrast agent dosage (196.4 ± 116.8) ml. CIN patients had a higher risk score (12.00 ± 2.90) than non-CIN (4.55 ± 3.9) patients. The incidence of CIN in theophylline group was significantly lower than in the sodium bicarbonate group alone (1.6% vs 7.9%; P = 0.015). There were only 2 cases of CIN in theophylline group and 10 cases in the control group, the difference was statistically significant (P = 0.015). 1 in theophylline group and 2 in the control group showed oliguria. According to the CIN risk score, there was no significant decrease in the incidence of CIN after low-risk use of theophylline, and the incidence of CIN was significantly lower in moderate-to-severe-risk patients (P = 0.014). Conclusion Theophylline can reduce the incidence of CIN.