南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (9): 1436-1438.doi: 10.12122/j.issn.1673-4254.2021.09.22

• • 上一篇    

半剂量荧光素钠造影剂对轻中度慢性肾病患者肝肾功能的影响——回顾性队列研究

李 莹，石 磊，贾 亮，张鸿瑫   

  1. 解放军总医院第三医学中心眼科医学部，北京 100853；解放军总医院京南医疗区，北京 100036
  • 出版日期:2021-09-20 发布日期:2021-09-30

Effect of half-dose fluorescein sodium contrast agent on liver and kidney functions in patients with mild to moderate chronic kidney disease: a retrospective cohort study

LI Ying, SHI Lei, JIA Liang, ZHANG Hongtao   

  1. Senior Department of Ophthalmology, the Third Medical Center of PLA General Hospital, Beijing 100853, China; Southern Medical Branch of PLA General Hospital, Beijing 100036, China
  • Online:2021-09-20 Published:2021-09-30

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摘要： 目的 观察半剂量荧光素钠造影剂对轻中度慢性肾病（CKD 1-3期）患者肝、肾功能的影响。方法 纳入2017年1月~2021年1月住院的77例肾功能正常及轻中度异常的慢性肾病患者，应用半剂量荧光素钠进行眼底荧光造影（FAG）检查。测定造影前3 d内和术后1、3、7、30±1 d的肝功能、血肌酐、血尿素氮（BUN）、尿β2微球蛋白（β2—MG）、肾小球滤过率（eGFR）等，分析造影剂对患者肾功能的影响。结果 77例患者中，男性50例，女性27例，年龄53.5±9.6岁，只有1例发生造影剂肾病，发病率为1.30%。FAG前后BUN、尿β2-MG、快速微量白蛋白/肌酐差异均无统计学意义（P>0.05）。血肌酐在 FAG后1、7 d均无升高，3 d升高值24.6±2.3（P<0.01），30 d升高16.0±21.7（P=0.239）。尿NAG酶、尿渗透压在FAG术后1、3、7、30 d均明显降低（P<0.01）。eGFR在术后第3天显著下降，下降值为10.23±0.62，术后第7天恢复正常。尿白蛋白定量在FAG术后1、3、7、30 d均明显降低（P<0.01）。血β2-MG在FAG术后3 d升高0.314±0.121（P<0.01），术后7 d降低0.134±0.143（P=0.391），术后30 d升高0.119± 0.058（P=0.402）。造影前后的转氨酶在术后第3、7天下降（P<0.01）。结论 半剂量荧光素钠对轻中度慢性肾病患者肝脏功能无明显影响，肾脏功能影响极小，可以安全的进行眼底荧光血管造影检查。

关键词: 荧光血管造影；轻度慢性肾病；肾小球滤过率

Abstract: Objective To observe the effect of half-dose fluorescein sodium (FINa) contrast agent on liver and kidney functions in patients with mild to moderate (stage 1 to 3) chronic kidney disease (CKD) and the incidence of contrast-induced nephropathy (CIN). Methods Seventy-seven patients (including 50 male and 27 female patients with an mean age of 53.5±9.6 years) with CKD with normal renal function or mild to moderate abnormalities underwent fundus fluorescein angiography (FFG) examination with half-dose FINa. Liver function, blood creatinine (Scr), blood urea nitrogen (BUN), urine β2 microglobulin (β2-MG), and glomerular filtration rate (eGFR) of the patients were measured within 3 days before intravenous injection of the contrast agent and at 1, 3, 7, and 30±1 days after the operation to analyze the effect of the contrast agent on renal function. Results Among the 77 patients, CIN occurred only in one case with an incidence rate of 1.30%. BUN, urine β2-MG, or rapid microalbumin/creatinine did not vary significantly after FFA in these patients. Scr levels showed no significant increments at 1 day and 7 days after FFA, but increased significantly at 3 days (24.6±2.3; P<0.01) and 30 days (16.0±21.7; P<0.05). Urine NAG enzymes and urinary osmolality were significantly reduced at 1, 3, 7, and 30 days after FFA (P<0.01). The eGFR decreased significantly to 10.23±0.62 at 3 days after FAG and became normal at 7 days. Urine albumin level decreased significantly at 1, 3, 7, and 30 days after FFA (P<0.01). Blood β2-MGFAG level increased significantly at 3 days after FFA (0.314± 0.121; P<0.01), but decreased to 0.134±0.143 at 7 days (P<0.05). The level transaminase decreased significantly at 3 and 7 days after FFA (P<0.01). Conclusion Half-dose of FINa has no significant effect on liver function and has only minimal effect on kidney function in patients with mild to moderate CKD, and FFA with half-dose FINa can therefore be safely performed in these patients.

Key words: fluorescein angiography; mild chronic kidney disease; glomerular filtration rate