贫血对冠心病患者冠状动脉介入治疗术后急性造影剂肾损伤的影响

Objective The aim of the present study was to assess the influence of anemia on devel-opment of contrast-induced acute kidney injury ( AKI) after percutaneous coronary intervention.Methods The subject group consisted of 1026 patients who had undergone coronary intervention procedure between January 1,2008 and October 31,2009. A nonionic,low osmolality contrast agent was used in our la-boratory at this time. Serum creatinine values were measured before and within 48 h of administration of con-trast agents. Contrast-induced nephropathy was defined as an increase of 0. 5 mg/dl or 25% in serum creati-nine concentration over baseline within 48 h of angiography, anemia as hemoglobin ( Hb) < 120 g/L in women and < 130 g/L in men. Results Among the 1026 patients studied,32(3. 1% ) experienced AKI af-ter procedure. AKI occurred in 6. 3% of the anemic patients and 2.2% of the non-anemic patients (P <0. 01). The incidence of AKI increased with decreasing of baseline estimated glomerular filtration rate ( eG-FR)in both the anemia and non-anemia groups. In patients with baseline eGFR < 30 ml· mi-1·(1. 73 m2 ) -1 ,a high proportion of both anemic and non-anemic patients experienced (24. 6% vs. 18. 5% ).When baseline eGFR was 30-59 ml·min-1·(1. 73 m2)-1 ,the incidence of in anemic patients was 2-fold higher than in non-anemic patients (7. 9% vs. 3. 8% ;P <0. 05). The amount of the contrast agent adminis-tered was similar for AKI and non- AKI patients [ (182 ±46)ml vs. (176±48) ml,P>0.05) ]. Multivariate Logistic regression analysis found that baseline eGFR and baseline hemoglobin were independent predictors of AKI. When presence of anemia was introduced into the multivariate model instead of baseline hemoglobin, it was also showed a significant association with AKI. Conclusions Anemia increases the incidence of AKI in patients with moderate renal dysfunction. Patients with both preexisting renal insufficiency and anemia are at high risk of AKI. Baseline eGFR and baseline hemoglobin (or anemia) are independent predictors of AKI.

肾源性系统性纤维化与钆对比剂相关性探讨

肾源性系统性纤维化(nephrogenic systemic fibrosis,NSF)是一种见于严重肾病人群的多系统性纤维化病变,常以广泛性皮肤增厚变硬为首发症状,继有广泛性多系统性纤维化.临床研究表明不当使用基于钆对比剂(gadolinium based contrast agents,GBCAs)的三维动态增强磁共振血管成像(3D CE-MRA)可导致NSF发生.

MR对比剂的临床应用及研究进展

尽管MR具有多序列、多参数、多方位成像以及较高的软组织分辨力,但在实际工作中发现某些病变与正常组织的T1甚至T2弛豫时间无明显差别.另外,有些病变虽有明显的异常信号,但诊断与鉴别诊断仍较困难,还有些病变较小,平扫不易显示.在这些情况下,我们需要应用MR对比剂来帮助解决.

钆造影剂与肾源性系统性纤维化

肾源性系统性纤维化(NSF),初认为是一种皮肤疾病,因此被称作为肾源性纤维化性皮肤病(NFD),2000年由Cowper等[1]首次提出.1997年01月发现首个病例,此后,耶鲁大学NSF注册中心报道NSF超过360例,美国食品药品监督管理局药品(FDA)登记NSF超过500例.耶鲁大学NSF注册中心报道的NSF病例,全部是肾衰竭者.近年来,研究人员发现除皮肤外,多个系统脏器发生纤维化损害[2],如食管、心、肺、骨骼肌、肾脏等纤维化病变,因此将NFD更名为NSF[3].2006年,Grobner[4]提出NSF与磁共振血管造影成像中使用钆对比剂(gadolinium-based contrast agents,GBCAs)有关.本文就NSF的临床特征、发生机制以及钆造影剂的分类特点进行综述.

Objective:To investigate the correlation of abdominal aorta CT value,renal artery CT value and renal cor-tex thickness with renal cortex CT value on contrast enhanced 64-slice CT images.Methods:96 patients (50 men and 46 women;16~74 years)with normal kidney function,which was confirmed by kidney function test were enrolled in this stud-y,including bilateral kidneys of 92 cases and unilateral kidney of 4 cases (total of 188 kidneys;92 left,96 right).After intra-venous (IV)injection of contrast agent the kidneys of the selected patients were scanned by MDCT.The scans were per-formed in arterial,venous and 3min delayed phases.All statistical analyses were performed by using IBM SPSS 20.0.Graphs were generated using Graph Pad Prism 5 software.Quantitative data were presented as mean ± standard deviation,while qualitative data were presented as frequency (%).P<0.05 was considered to be statistically significant.Results:The mean renal cortex thickness was (5.19±0.81)mm in all kidneys.In the arterial phase,a statistically significant positive correla-tion between renal cortex CT values and abdominal aortic CT values was showed (r= 0.584;P<0.001).A statistically sig-nificant positive correlation between renal cortex CT values and renal cortex thickness was demonstrated (r= 0.533,P<0.0001).Likewise,there was a positive correlation between renal cortex CT value and renal artery CT values (r= 0.43,P<0.001).Conclusion:It is a promising approach to assess the individual kidney function by measuring abdominal aorta CT value,renal artery CT value,renal cortex CT value and renal cortex thickness using contrast MDCT.

肾源性系统性纤维化与磁共振含钆对比剂

自二十世纪八十年代第一种钆对比剂(gadolinium-based contrast agents,GBCA)马根维显(Magnevist)应用于临床以来,GBCA一直被认为是一种安全可靠、低肾毒性的对比剂,而广泛应用于磁共振增强扫描和磁共振血管成像(magnetic resonance angiography,MRA).

靶向声学造影技术的研究现状与进展

超声造影剂(ultrasound contrast agents,UCA)是利用声波对气体反射比液体大近1 000倍的原理,使用含气微泡后超声回声增强得到更高的对比分辨力,从而有利于疾病的诊断.至今,有关超声造影剂的研究已有近30年的历史[1].过去几年中,靶向微泡的开发已取得可观进展.这种微泡对于靶向病变组织有一定亲和力,可以附着于某种疾病的特殊标记物,靶向微泡在病变组织的积聚可实现分子和细胞过程的无创性超声成像.本综述主要讨论靶向微泡分子成像的早期实验和对比增强超声分子成像具体应用的靶向方法.

磁共振分子对比剂在肿瘤诊断中的应用及研究进展

恶性肿瘤发病率近年来逐渐上升,成为引起死亡的首要原因之一.发展特异性强,敏感度高的影像诊断手段,对肿瘤的早期发现、早期治疗具有重要意义.磁共振成像(MRI)现已广泛运用于良恶性肿瘤的诊断和鉴别诊断,由于肿瘤组织与正常组织中原子核自旋弛豫率差异及肿瘤新生血管与正常血管灌注率差异(运用于动态对比增强MRI,DCE MRI),在MRI图像中可产生对比,可用于区分肿瘤组织和正常组织.然而,基于上述诊断原理的MRI成像方法由于其特异度较低,难以应用于早期肿瘤的诊断.因此,在近年来,针对于肿瘤组织特异分子及肿瘤组织特异微环境的磁共振分子对比剂受到了极大的关注.

MR主要对比剂及功能成像在小肝癌中的应用及新进展

肝细胞癌是世界上第六大常见恶性肿瘤,占癌症死亡原因的第3位[1].对小肝癌(small hepatocellular carcinoma,SHCC)的早期检出并及时治疗是延长患者生存期的关键,由于MRI自身的优点,使其在SHCC诊断方面有重要价值.