碘对比剂引起急性肾损伤的相关危险因素分析

目的探讨不同程度碘对比剂后急性肾损伤的危险因素及其转归预后。方法筛选2016年4月1日至2019年8月31日于重庆医科大学附属第三医院住院期间发生碘对比剂后急性肾损伤(PC-AKI)的患者,按照急性肾损伤分层标准将其分为非严重损伤组(A组)和严重损伤组(B组),从基本人口学资料、基础疾病、药物使用情况、转归预后等方面分析两组患者的特点及差异。结果 1 920例患者中发生PC-AKI者90例,其中A组72例(80.00%),B组18例(20.00%),B组中最终需肾脏替代治疗(血液透析)干预者11例(12.22%)。A组与B组间一般情况、基础肾功能、碘对比剂的使用以及联用肾毒性药物、静脉水化量等观察指标无统计学差异。B组合并慢性疾病者更多,其中冠心病(55.56%vs 29.17%)、心肌梗死(27.78%vs 5.56%)患病率差异具有统计学意义(P<0.05),行血液透析的患者第一诊断为心肌梗死者占45.45%。65.85%的患者在使用对比剂后10 d内肌酐仍高于基线,54.54%的透析患者在出院时仍需透析治疗,81.81%的透析患者出院时死亡或放弃治疗。结论合并冠心病、心肌梗死的患者更容易发生严重PC-AKI,当合并这些疾病的患者使用碘对比剂时,临床医师应密切关注其肾功能的变化。PC-AKI的肾功转归较差,发生PC-AKI后需透析治疗的患者往往预后不良。

Risk factors of post-contrast acute kidney injury caused by iodine contrast agent

Objective To investigate the risk factors and prognosis of different degrees of post-contrast acute kidney injury. Methods A retrospective analysis was performed for the patients admitted to The Third Affiliated Hospital of Chongqing Medical University from April 2016 to August 2019, the patients who met the diagnostic criteria of post-contrast acute kidney injury(PC-AKI) were divided into without serious injury group(group A) and serious injury group(group B), the characteristics and differences between two groups were analyzed by collecting the medical records of basic demographic datas, diseases, drugs and outcomes. Results 90 patients were diagnosed with PC-AKI among the 1 920 patients, including 72 patients(80.00%) in group A and 18 patients(20.00%)in group B, 11 patients in group B were treated with renal replacement therapy(hemodialysis) after useing iodine contrast agent.There were no significant differences in general information, basic renal function, use of iodine contrast agent, nephrotoxic drug and intravenous hydration between two groups. Patients in group B had the higher prevalence of chronic diseases, especially the coronary heart disease(55.56% vs 29.17%) and myocardial infarction(27.78% vs 5.56%)(P < 0.05), myocardial infarction was the first diagnosis in 45.45% of the patients requiring hemodialysis. 65.85% of patients had a creatinine above baseline within 10 days after using contrast agent, 54.54% of the patients requiring hemodialysis couldn’t stop receiving hemodialysis prior to discharge,81.81% of the patients requiring hemodialysis died or gave up the treatment prior to discharge. Conclusion Patients with coronary heart disease or myocardial infarction were more likely to have severe PC-AKI. Doctors should pay close attention to patients’ renal function after using contrast agent, especially when they had these dieases. The renal function of most patients with PC-AKI didn’t return to baseline, the patients requiring hemodialysis after PC-AKI usually had poor outcomes.