| Background:With the continuous increase in the number of operations of percutaneous coronary intervention（PCI）in China,the number of contrast media induced nephropathy（CIN）is also increasing,and clinical doctors pay more and more attention to it.The emergence of CIN will not only increase the incidence rate of renal damage,increase the risk of serious ill conscience,but also prolong the hospitalization time of patients,thus increasing the huge financial burden of family and society.Among the general population without risk factors,the prevalence of CIN was relatively low,about 1%-2%,but the prevalence of CIN was significantly higher in CIN high-risk groups,such as those with type 2 diabetes.Due to the fact that the pathogenesis of contrast induced nephropathy is not yet understood,it is not possible for people who have coronary heart disease and type 2 diabetes to effectively prevent CIN in interventional therapy.At present,the choice of hypotonic drugs such as metformin before and after operation is still in the initial stage of debate,but there is still a consensus on the length of use of hypotonic drugs such as metformin before and after operation.At present,the most commonly used isotonic agents and low osmotic contrast agents in the market are choosing what type of contrast agents to intervene in patients with coronary heart disease and type 2 diabetes.The intervention can reduce the impact on renal function and reduce the incidence rate of CIN.Objective:This study is to compare the effects of isosmotic contrast agent Iodixanol and Iobitridol on the renal function after percutaneous coronary intervention in patients with coronary heart disease and type 2 diabetes mellitus,the incidence of CIN and the incidence rate of Major Adverse Renal and Cardiac events（MARCE）.This is a reference for selecting high-risk and high-risk group of patients to choose the most suitable and safe contrast medium for interventional therapy.Methods:From July 2021 to February 2022,patients with coronary heart disease complicated with type 2 diabetes who received concurrent interventional treatment in the Department of Cardiovascular Medicine of Jiangxi Provincial People’s Hospital were selected.All the enrolled patients were divided into Iodixanol group and Iobitridol group using random number table method.Iodoxanol group:Visipaque（50ml:16 g）manufactured by GE Ireland;Iobitridol group:XENETIX（100ml:35g）manufactured by GUERBET,France.Baseline clinical data,operative and postoperative data of all patients were collected,and renal function indicators of all patients were collected before and after 24h,48h and 72h,and the occurrence of major unconscionable renal events during follow-up were recorded.After collecting and recording the data required above,IBM SPSS 22.0 software was used for data analysis,and the incidence of intraoperative adverse events,changes in renal function,incidence of CIN,and the occurrence of major unintentional renal events within one month after follow-up were compared between the two groups.P<0.05 was considered to be statistically significant.Result:1.A total of 996 patients were included in this study,including 496 patients in the Iodixanol group and 500 patients in the Iobitridol group.There were no statistically significant differences in baseline clinical data,preoperative medication regimen,hydration regimen,surgical regimen,intraoperative contrast agent dosage and operative time between the two groups（P>0.05）.There was no significant difference in preoperative renal function between the two groups in terms of creatinine,urea nitrogen and estimated glomerular filtration rate（e GFR）level,which was comparable（P>0.05）.2.Comparison of the occurrence of intraoperative adverse reactions between the two groups:in the Iodixanol group,3 patients（0.60%）had acute intraoperative elevated blood pressure,2（0.40%）had intraoperative decreased blood pressure,1（0.40%）had intraoperative chest pain and discomfort requiring morphine for intravenous analgesia,and 1（0.40%）had skin allergic reaction.In the Iobitridol group,4 cases（0.80%）had an acute increase in intraoperative blood pressure,1（0.20%）had intraoperative abdominal pain,which improved after intramuscular injection of anisodamine,1（0.20%）had skin allergic reaction,1（0.20%）had intraoperative vagal hyperreflexia,blood pressure and heart rate decreased,and improved after intravenous injection of atropine.There was no significant difference in intraoperative adverse reactions between the two groups（P>0.05）.3.Comparison of changes of renal function after PCI:（1）Intra-group comparison:（1）The Serum creatinine（Scr）level in Iodixanol group was significantly increased at 24h and 48h after PCI compared with baseline（P=0.011,0.029）,and the Scr level reached the maximum at 24h after PCI,then gradually decreased and recovered to baseline at 72h（P>0.05）;The level of Blood urea nitrogen（BUN）increased to the peak value 24h after PCI（P=0.015）,then gradually decreased,and the BUN level decreased to the baseline level 48h and 72h after PCI（P>0.05）.e GFR level decreased significantly from baseline at 24h and 48h after PCI（P=0.037,0.041）,reached the lowest value at 24h after PCI,then gradually recovered,and recovered to baseline at 72h after PCI（P>0.05）.（2）In Iobitridol group,Scr level increased significantly at 24h and 48h after PCI compared with baseline（P=0.021,0.044）,Scr level also increased to the maximum at 24h after PCI,and then decreased gradually to the baseline at 72h（P>0.05）;The BUN level also increased to the peak value 24h after PCI（P=0.031）,and then gradually decreased,and basically decreased to the baseline level 48h and 72h after PCI（P>0.05）.e GFR levels also decreased significantly compared with baseline at24h,48h and 72h after PCI（P=0.018,0.036,0.042）.e GFR levels reached the lowest value at 24h after PCI and gradually recovered,but still did not return to baseline by 72h after PCI.（2）Comparison between groups:24h after PCI,the level of Scr in Iobitridol group was significantly higher than that in Iodixanol group（90.06±19.63mol/L VS84.78±20.15mol/L,P=0.012）;The BUN level of Iobitridol group was significantly higher than that of Iodixanol group（8.03±1.88mmol/L VS 7.44±1.58mmol/L,P=0.029）.e GFR level in Iobitridol group was significantly lower than that in Iodixanol group at 24h and 48h after PCI(122.39±45.19ml.min-1.1.73m-2 VS130.35±49.55 ml.min-1.1.73m-2,123.18±38.36 ml.min-1.1.73m-2 VS 132.21±57.54ml.min-1.1.73m-2,P=0.022,0.018).4.Comparison of the occurrence of CIN after PCI:17 patients（3.43%）in the Iodixanol group developed CIN,while 37 patients（7.40%）in the Iobitridol group developed CIN.The incidence of CIN in the Iobitridol group was significantly higher than that in the Iodixanol group（P=0.020）,but the overall incidence of CIN（5.42%）was lower than that in other previous studies.5.Comparison of MARCE events within 1 month after PCI:Within 1 month after surgery,3 patients（0.61%）in the Iodixanol group and 5 patients（1.0%）in the Iobitridol group developed recurrent angina,and 1 patient（0.21%）in the Iodixanol group and 1 patient（0.21%）in the Iobitridol group developed Acute Kidney injury（AKI）.There was no significant difference in incidence between the two groups（P>0.05）.There were no fatal MARCE events or re-hospitalization within 1 month in either group.Conclusion:1.After interventional therapy in patients with coronary heart disease complicated with type 2 diabetes,no matter which type of contrast agent is used,Scr and BUN will increase and e GFR will decrease within 1-3 days.Most patients can gradually recover to the level before the use of contrast agent,but the time required for this change varies among different contrast agent groups.2.Compared with the low-otonic contrast agent Iobitridol,patients in the isootonic contrast agent Iodixanol group had a faster recovery of renal function,suggesting that the metabolic rate of Iodixanol in patients with coronary heart disease accompanied by type 2 diabetes was faster than that of Iobitridol,and the effect time on kidney was shorter.3.In the interventional treatment of patients with coronary heart disease complicated with type 2 diabetes,compared with low-permeability contrast agent Iobitridol,isotonic contrast agent Iodixanol has less effect on renal function and a lower incidence of CIN. |
PDF Full Text Request