口服二甲双胍的糖尿病患者能否进行荧光素眼底血管造影?

doi:10.24920/J1001-9294.2017.015

摘要/Abstract

摘要：

二甲双胍是一种广泛应用于糖尿病治疗的双胍类降糖药。在临床实践中,荧光素眼底血管造影（fundus fluorescein angiography,FFA）前是否应该停用二甲双胍尚存在分歧。一些内分泌医生建议在FFA检查前停用二甲双胍,然而眼科医生在实践中并不总是认同这一观点,这种情况有时会导致不必要的医患纠纷。本文分析了造影剂肾病（contrast-induced nephropathy, CIN）的原因及相关造影剂特性,同时回顾文献中荧光素血管造影的不良反应发生情况,提出这种认识上的差异可能是由对所使用的造影剂的误解造成。糖尿病患者进行碘造影剂的血管造影发生CIN的危险性增高,必须停止二甲双胍;然而,目前尚未有使用荧光素钠进行FFA检查时发生CIN的报道。因此,FFA对口服二甲双胍的糖尿病患者是安全的,检查前没有必要停用二甲双胍。

关键词: 荧光素眼底血管造影, 糖尿病, 二甲双胍, 造影剂肾病

Abstract:

Metformin is a kind of biguanide hypoglycemic agent that has been widely used in patients with diabetes mellitus. In clinical practice, whether metformin should be stopped before Fundus fluorescein angiography (FFA) remains largely unclear. Some endocrinologists suggest stop metformin before FFA. However, ophthalmologists do not always adopt this opinion in their practice. This situation may lead to disputes between physicians and patients. This article analyzed contrast-induced nephropathy(CIN) and the related contrast agent, as well as the adverse reactions of fluorescein angiography. It pointed out that the discrepancy may be caused by misunderstanding of contrast agents used in FFA. For angiography using iodine contrast agent, metformin must be stopped because of the increased possibility of CIN, while for FFA using fluorescein sodium, no CIN has been reported yet. Therefore, the authors believe FFA is safe for diabetic patients with oral metformin and it is unnecessary to stop metformin before the examination.

Key words: fundus fluorescein angiography, diabetes mellitus, metformin, contrast-induced nephropathy

Du Junhui, Li Rong. Can Fundus Fluorescein Angiography be Performed for Diabetic Patients on Oral Metformin?^△[J].Chinese Medical Sciences Journal, 2017, 32(2): 119-122.

图/表 1

参考文献 25.

1.	Azzalini L, Spagnoli V, Ly H Q.Contrast-induced nephropathy: from pathophysiology to preventive strategies. Can J Cardiol 2016;32:247-55. doi:10.1016/j.cjca.2015.05.013.
2.	Mruk B.Renal safety of iodinated contrast media depending on their osmolarity-current outlooks. Pol J Radiol 2016; 81:157-65. doi:10.12659/PJR.895406.
3.	Gruberg L, Mehran R, Dangas G, et al.Acute renal failure requiring dialysis after percutaneous coronary interventions. Catheter Cardiovasc Interv 2001; 52: 409-16. doi:10.1002/ccd.1093.
4.	Moore RD, Steinberg EP, Powe NR, et al.Nephrotoxicity of high-osmolality versus low-osmolality contrast media: randomized clinical trial. Radiology 1992; 182:649-55. doi:10.1148/radiology.182.3.1535876.
5.	Heyman SN, Rosenberger C, Rosen S, et al.Why is diabetes mellitus a risk factor for contrast-induced nephropathy? Biomed Res Int 2013; 2013: 123589. doi:10. 1155/ 2013/123589.
6.	Mueller C, Buerkle G, Buettner HJ, et al.Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002; 162:329-36. doi:10.1001/archinte.162.3.329.
7.	Assareh A, Yazdankhah S, Majidi S, et al.Contrast induced nephropathy among patients with normal renal function undergoing coronary angiography. J Renal Inj Prev 2016; 5: 21-4. doi:10.15171/jrip.2016.05.
8.	Soma V R, Cavusoglu E, Vidhun R, et al.Contrast-associated nephropathy. Heart Dis 2002; 4: 372-9. doi:10.1097/01.HDX.0000038530.32977.2F.
9.	Malik A.Prevention of contrast-induced acute kidney injury. Br J Hosp Med 2015; 76:685-9. doi:10.12968/ hmed.2015.76.12.685.
10.	Bruijstens LA, van Luin M, Buscher-Jungerhans PM, et al. Reality of severe metformin-induced lactic acidosis in the absence of chronic renal impairment. Neth J Med 2008; 66:185-90.
11.	Stacul F, van der Molen AJ, Reimer P, et al. Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 2011; 21:2527-41. doi:10.1007/s00330-011-2225-0.
12.	Heng LZ, Comyn O, Peto T, et al.Diabetic retinopathy: pathogenesis, clinical grading, management and future developments. Diabet Med 2013; 30: 640-50. doi:10. 1111/dme.12089.
13.	Zhang K, Wang Y, Chen XL. Fluorescein fundus angiography for early diagnosis of diabetic retinopathy significance. J Clin ophthalmol 2015; 23: 323-5. Chinese. doi:10.3969/j.issn.1006-8422.2015.04.012.
14.	Lv G, Tang LZ, Meng J. The significance of fundus fluorescein angiography after panretinal photocoagulation. Chin J Ocular trauma and occupational eye disease 2015; 37: 295-7. Chinese. doi:10.3760/cma.j.issn.2095-1477.2015.04.016.
15.	Jost G, Lengsfeld P, Lenhard DC, et al.Viscosity of iodinated contrast agents during renal excretion. Eur J Radiol 2011; 80: 373-7. doi:10.1016/j.ejrad.2011.02.003.
16.	Kwan AS, Barry C, McAllister IL, et al. Fluorescein angiography and adverse drug reactions revisited: the Lions Eye experience. Clin Experiment Ophthalmol. 2006; 34: 33-8. doi:10.1111/j.1442-9071.2006.01136.x.
17.	Karhunen U, Raitta C, Kala R.Adverse reactions to fluorescein angiography. Acta Ophthalmol (Copenh) 1986; 64:282-6.
18.	Butner RW, McPherson AR. Adverse reactions in intravenous fluorescein angiography. Ann Ophthalmol 1983; 15:1084-6.
19.	Kwiterovich KA, Maguire MG, Murphy RP, et al.Frequency of adverse systemic reactions after fluorescein angiography. Results of a prospective study. Ophthalmology 1991; 98:1139-42.
20.	Lira RP, Oliveira CL, Marques MV, et al.Adverse reactions of fluorescein angiography: a prospective study. Arq Bras Oftalmol 2007; 70: 615-8.
21.	Ma H. Clinical observation on adverse reactions of fluorescence fundus angiography. Chin J ocular fundus disea. 2011; 27: 175-6. Chinese. doi:10.3760/cma.j.issn.1005-1015.2011.02.018.
22.	Liu J, Zhou J, Fang L. Fundus fluorescein angiography fluorescein sodium is used to analysis of 2620. Chin J Misdiagnosis 2008; 8: 8443. Chinese. doi:10.3969/j.issn.1009-6647.2008.34.120.
23.	Wei GC, Sun W. The adverse reactions of fluorescence fundus angiography and its countermeasures. Chin J Practical Ophthalmology 2006; 24: 636-7. Chinese. doi:10.3760/cma.j.issn.1006-4443.2006.06.030.
24.	Yannuzzi LA, Rohrer KT, Tindel LJ, et al.Fluorescein angiography complication survey. Ophthalmology 1986; 93: 611-7.
25.	Su ZA, Zhang LX, Teng Y. Special groups of the adverse reactions of fluorescence fundus angiography. Chin Med J 2009; 89: 1490-2. Chinese. doi:10.3760/cma.j.issn.0376-2491.2009.21.015.

Author of studies	Number of cases	Incidence in total (%)	Adverse reactions
Author of studies	Number of cases	Incidence in total (%)	Nausea or vomiting (%)	Itching or rash (%)	Dizziness or sweating (%)	Others^a (%)	Severe adverse reactions^b(%)
Kwan et al¹⁶	11898	1.1	1.1	0.2	0.3	0.2	0
Karhunen et al¹⁷	9909	7.26	5.9	0.5	0.6	0.26	0.03
Butner et al¹⁸	5000	4.82	4.02	0.34	-	-	0
Kwiterovich et al¹⁹	2789	4.8	4.1	0.5	-	0.2	0
Lira et al²⁰	1500	9.24	8.18	1.06	-	-	0.3
Ma H et al²¹	3565	2.50	1.18	0.67	-	0.56	0.8
Liu J et al²²	2620	0.34	0.07	0.07	0.07	0.11	0
Wei GC et al²³	1119	7.06	5.27	0.36	0.71	0.71	0

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