A Comparative Study For Iohexol And Ioversol Effects On Renal Function In Patients With Coronary Artery Intervention Treatment

objective:To compare the effects that iohexol and ioversol on the incidence of renal function of contrast induced nephropathy(CIN) and renal function in patients by percutaneous coronary intervention(PCI); to investigate the related risk factors of CIN for patients after PCI; and to evaluate the preventative effect on CIN for the PCI patients with different dose of atorvastatin. Methods: According to the inclusion criteria and exclusion criteria, 140 cases of patients for PCI have been chosen as research subjects by the third people’s hospital of Mianyang from June 2013 to March 2015,which is randomly divided into iohexol group and ioversol group(74 cases for iohexol group, 66 cases for ioversol group). All the patients have been operated in accordance with the balloon angioplasty and stent implantation. It has been recorded that patients’ general condition such as age, sex, body mass index(BMI), whether to have hypertension and diabetes, the usage of basic drugs(angiotensinconverting enzyme inhibitors or angiotensin receptor blocker, atorvastatin) before PCI, as well as the laboratory indexes like renal function, serum lipids, urine examination, blood routine test. The indexes such as erum creatinine(Scr), boold urea nitrogen(BUN), uricacid(UA) and glomerular filtration rate(GFR), urine β2- microglobulin(β2-MG), N-terminal pro-brain natriuretic peptide(NT-pro-BNP), cystatin C(Cys C) have been taken as the baseline values which measured at any time within a week before PCI. The record for renal function, urine examination, NT-pro-BNP, Cys C within 48-72 h after PCI have also been kept; as well as the information for dosage of contrast material,the number of coronary lesion and stent placement, the contact time of contrast material, etc. It has been taken the standard for CIN used by european society of urogenital radiology(ESUR) in 2011. It has been analyzed the incidence of CIN and renal function of two groups of patients. Logistic regression is used to analyze the high risk factors of CIN, and the preventive effect of different doses of atorvastatin on CIN in the subgroup analysis has been investigated. Results: The incidences of CIN for iohexol and ioversol are 10.8%(8/74) and 10.6%(7/66) respectively, there is no statistical difference(P > 0.05). When compared the Scr、GFR、BUN、β2-MG and Cys C,it is showed no obvious difference between two groups( P > 0.05); but compared the baseline, Scr、BUN、β2-MG and Cys C of the two groups increases significantly( P<0.05), GFR decreased significantly( P < 0.05).Through multiple regression analysis, it is found that type 2 diabetes(OR = 9.560,95%CI: 2.428~ 37.650,P=0.001), two stents implantation(OR = 6.252,95%CI: 1.053~ 37.125,P=0.044), three and abovestents implantation(OR=12.499,95%CI: 1.863~ 83.847,P=0.009) are independent risk factors for CIN. No significant differences are found when compared the effects of 20 mg atorvastatin and 40 mg atorvastatin on the incidence of CIN, Scr and GFR(P>0.05). Conclusion: It has no significant differences in the incidence of CIN and renal function for PCI patients with ioversol or iohexol.Type 2 diabetes and coronary artery implanting two and above stents are independent risk factors for CIN in PCI patients. It doesn’t show any benefits for PCI patients to take large dose of atorvastatin to prevent CIN before operation.