脑血管介入术后对比剂致急性肾损伤的危险因素分析  

Analysis of risk factors of contrast-induced acute kidney injury after cerebrovascular intervention

作　　者：陶一鸣[1,2] 陈源汉[2] 罗嘉伦[1] 李志莲[2] 徐嘉琪[1] 莫立仪 董伟[1,2] 李锐钊[2] 史伟[2] 梁馨苓[2] 

机构地区：[1]南方医科大学,广州510515 [2]广东省医学科学院广东省人民医院肾内科

出　　处：《中国脑血管病杂志》2014年第12期624-629,672,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金项目(81170683);广州市科技计划项目(12C166041933);国家临床重点专科建设项目

摘　　要：目的：探讨脑血管介入术后对比剂致急性肾损伤（CI-AKI）的相关危险因素。方法回顾性分析2005年1月—2013年12月广东省人民医院神经内科和神经外科进行脑血管造影介入术的5423例患者的临床资料，对行脑血管造影介入术患者进行评估和筛选，建立临床病史资料数据库。入选患者均使用等渗对比剂碘克沙醇。以发生CI-AKI为观察终点，将患者分为CI-AKI组和非CI-AKI组。采用多因素Logistic回归模型对与CI-AKI发生相关的危险因素进行分析。结果共入选4164例患者，其中137例发生CI-AKI，发生率为3.3％。多因素Logistic回归分析结果显示，年龄＞60岁（OR＝1.965，95％CI：1.244～3.136）、基线估算肾小球滤过率（eGFR）＜60 ml／（min·1.73 m2）（OR ＝4.163，95％ CI：2.422～5.873）、糖尿病（OR ＝3.140，95％ CI：1.983～3.902）、贫血（OR＝1.524，95％CI：1.226～3.253）是脑血管造影介入术后发生 CI-AKI的危险因素。结论慢性肾脏病[eGFR＜60 ml／（min·1.73 m2）]、糖尿病、贫血、老年（年龄＞60岁）是脑血管造影介入术后发生CI-AKI的独立危险因素。Objective To investigate the related risk factors of contrast-induced acute kidney injury （CI-AKI）after cerebrovascular intervention. Methods The clinical data of 5423 patients performed cerebrovascular angiography and intervention at the Departments of Neurology and Neurosurgery,Guangdong People′s Hospital from January 2005 to December 2013 were analyzed retrospectively. The patients who underwent cerebrovascular angiography and intervention were evaluated and screened. A clinical history database was established. All the selected patients used iodixanol,an isotonic contrast agent. The occurrence of CI-AKI was used as an endpoint. The patients were divided into either a CI-AKI group or a non CI-AKI group. A multivariate Logistic regression model was used to analyze the risk factors associated with the occurrence of CI-AKI. Results A total of 4164 patients were finally enrolled,including 137 had CI-AKI. The incidence of CI-AKI was 3. 3%. The results of multivariate Logistic regression showed that age 〉60 years （OR,1. 965,95%CI 1. 244-3. 136）,baseline estimated glomerular filtration rate （eGFR）〈60mL/（min·1. 73 m2）（OR,4. 163,95%CI 2. 422-5. 873）,diabetes （OR,3. 140,95%CI 1. 983-3. 902）,and anemia （OR,1. 524,95%CI 1. 226 -3. 253）were the influencing factors for occurring CI-AKI after cerebrovascular angiography and intervention. Conclusion Chronic kidney disease （eGFR〈60 mL/[min·1. 73 m2 ]）,diabetes,anemia,and old age （age 〉60 years）are the independent risk factors for occurring＆amp;nbsp;CI-AKI after cerebrovascular angiography and intervention.

关 键 词：脑血管造影术 对比剂 危险因素 急性肾损伤 

分 类 号：R651.12[医药卫生—外科学]