心脑血管病患者CT增强检查中非离子型碘对比剂相关急性不良反应预测模型的构建  

Construction of A Prediction Model for Acute Adverse Reactions Associated with Nonionic Iodine-contrast Agents in Patients with Cardio-cerebrovascular Disease

作　　者：宋卉 曾超[2] 廖凯 叶佳雨 Song Hui;Zeng Chao;Liao Kai;Ye Jia-yu(Department of Radiology,West China Hospital,Sichuan University,West China Nursing College,Sichuan University Chengdu 610041,Sichuan Province,China;Emergency Department of the Fourth People's Hospital of Zigong City,Zigong 643000,Sichuan Province,China)

机构地区：[1]四川大学华西医院放射科/四川大学华西护理学院,四川成都610041 [2]自贡市第四人民医院急诊科,四川自贡643000

出　　处：《中国CT和MRI杂志》2024年第4期13-16,共4页Chinese Journal of CT and MRI

基　　金：四川省重点研发项目(23ZDYF0116)。

摘　　要：目的探究心脑血管病患者CT增强检查中非离子型碘对比剂相关急性不良反应(ICM-AARs)预测模型构建的价值。方法选取2023年1月~2023年5月期间于四川大学华西医院进行CT增强检查的心脑血管病患者2031例,统计ICM注射后1h内AARs的发生情况,从2031例患者中选取符合纳入标准的未发生AARs的患者174例,纳入未发生ICM-AARs组,发生AARs的患者58例纳入ICM-AARs组,收集并比较两组患者临床资料,采用Logistic回归分析明确导致心脑血管病患者CT增强检查中发生AARs的危险因素。应用独立危险因素构建列线图预测模型,并采用受试者工作特征曲线(ROC)、Bootstrap法验及Calibration曲线对模型进行评价。结果2031例心脑血管病患者进行CT增强检查中发生ICM-AARs 58例,ICM-AARs发生率为2.86%;ICM-AARs组有过敏史、检查前未水化、未外预热、注射速率≥3.5mL/s、静脉注射及使用碘普罗胺的人数占比均高于未发生ICM-AARs组(P<0.05);Logistic回归分析结果显示,有过敏史、检查前未水化、未外预热、注射速率≥3.5mL/s、静脉注射及使用碘普罗胺是影响CT增强检查发生ICM-AARs的独立危险因素(P<0.05);ROC曲线显示,预测模型曲线下面积(AUC)为0.765(95%CI:0.706~818),灵敏度89.66%、特异度81.03%、约登指数0.706;Bootstrap法验证结果显示,C-index值为0.779(95%CI:0.713~0.861);Calibration曲线结果显示,Hosmer-Lemeshowχ^(2)=0.708,P=0.295。结论有过敏史、检查前未水化、未外预热、注射速率≥3.5mL/s、静脉注射及碘普罗胺均为心脑血管病患者CT增强检查中发生ICMAARs的独立危险因素,上述因素构建的列线图预测模型对ICM-AARs具有较高的预测效能。Objective To explore the value of building a prediction model for nonionic iodine-contrast associated acute adverse reactions(ICM-AARs)in patients with cardio-cerebrovascular disease.Methods 2031 patients with cardio-cerebrovascular disease who underwent CT enhanced examination in West China Hospital of Sichuan University from January 2020 to May 2023 were selected,and the incidence of AARs within 1h after ICM injection was analyzed.From the 2031 patients,174 patients without AARs who met the inclusion criteria were selected to be included in the non-ICM-AARS group,and 58 patients with AARs were included in the ICM-AARs group.The clinical data of the two groups were collected and compared.Logistic regression analysis was used to identify the risk factors leading to AARs in patients with cardiocerebrovascular disease during enhanced CT examination.The nomogram prediction model was constructed using independent risk factors.Receiver operating characteristic curve(ROC),Bootstrap test and Calibration curve were used to evaluate the model.Results ICM-AARs occurred in 58 cases of 2031 patients with cardio-cerebrovascular disease.The incidence of ICM-AARs was 2.86%.The proportion of patients in ICM-AARs group with history of allergy,no hydration before examination,no external preheating,injection rate≥3.5 mL/s,the proportion of patients in ICM-AARs group with intravenous injection and using ioprosamide were higher than those in ICM-AARS group without ICM-AARS(P<0.05).Logistic regression analysis showed that history of allergy,no hydration before examination,no external preheating,injection rate≥3.5 mL/s,intravenous injection and using ioprosamide were independent risk factors for ICM-AARs in enhanced CT examination(P<0.05).ROC curve showed that the area under the curve(AUC)of the prediction model was 0.765(95%CI:0.706~818),the sensitivity was 89.66%,the specificity was 81.03%,and the Yoden index was 0.706.The verification result of Bootstrap method showed that C-index value was 0.779(95%CI:0.713~0.861).Calibration c

关 键 词：心脑血管病 CT增强检查 非离子型碘对比剂 对比剂相关急性不良反应 预测 列线图 

分 类 号：R543[医药卫生—心血管疾病]