高龄患者应用碘克沙醇所致对比剂肾病的风险研究  

Risk study on contrast-induced nephropathy induced by iodixanol in elderly patients

作　　者：潘海燕 王宝彦[2] 钱云 杨婷 李俐 Pan Haiyan;Wang Baoyan;Qian Yun;Yang Ting;Li Li(Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University,Xuzhou 221004,China;Department of Pharmacy,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China;Dermatologic Surgery,Institute of Dermatology,Chinese Academy of Medical Sciences&Peking Union Medical College,Nanjing 210042,China)

机构地区：[1]徐州医科大学鼓楼临床学院,江苏徐州221004 [2]南京大学医学院附属鼓楼医院药学部,江苏南京210008 [3]中国医学科学院皮肤病医院皮肤病研究所皮肤外科,江苏南京210042

出　　处：《实用药物与临床》2024年第6期409-413,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨不同高龄患者应用碘克沙醇时发生对比剂肾病(Contrast-induced nephropathy,CIN)的风险差异。方法回顾性分析2021年1月至2022年12月在南京鼓楼医院血管外科收治的使用碘克沙醇进行影像学检查的高龄患者资料,统计患者基本资料及实验室检查指标,根据应用碘克沙醇前后的血清肌酐变化判断是否发生对比剂肾病,对各相关因素应用Logistic回归模型进行多因素分析,采用限制性立方样条图绘制肾小球滤过率、白蛋白及C反应蛋白与CIN风险的关系。结果与非CIN组相比,CIN组患者心功能不全、糖尿病例数、碘克沙醇使用剂量、eGFR分级、血红蛋白、尿酸、C反应蛋白以及白蛋白水平差异均有统计学意义(P<0.05),不同eGFR分期患者碘克沙醇应用前后的肌酐水平比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,心功能不全、糖尿病、使用剂量、eGFR分级3期、白蛋白以及C反应蛋白是高龄患者应用碘克沙醇后发生CIN的影响因素(P<0.05)。限制性立方样条图显示,肾小球滤过率、血清白蛋白及C反应蛋白与CIN风险存在非线性关系。结论心功能不全、糖尿病、使用剂量增加、eGFR3期、白蛋白<38.2 g/L及C反应蛋白>11.4 mg/L是高龄患者CIN发生的危险因素,此类患者使用碘克沙醇时,临床医生需进行危险因素评估。Objective To investigate the risk difference of contrast-induced nephropathy(CIN)in different elderly patient groups after using iodixanol.Methods Patients who underwent imaging examination with iodixanol in the Vascular Surgery Department of Nanjing Drum Tower Hospital from January 2021 to December 2022 were retrospectively analyzed.The baseline information and laboratory tests of the patients were collected.The occurrence of CIN was judged according to the changes of serum creatinine before and after iodixanol use.The related factors were analyzed by Logistic regression model.The relationship between eGFR,albumin,C-reactive protein and the risk of CIN was analyzed by restricted cubic spline plots,respectively.Results There were significant differences in the number of heart failure or diabetes,dosage of iodixanol,eGFR stages,hemoglobin,uric acid,C-reactive protein and albumin levels between non-CIN group and CIN group(P<0.05).There were significant differences in creatinine levels before and after iodixanol use among the patients with different eGFR stages(P<0.05).Multivariate Logistic regression analysis showed that heart failure,hypertension,diabetes,dosage,eGFR stage 3 and albumin were influencing factors for CIN in elderly patients after use of iodixanol(P<0.05).Restricted cubic spline analysis showed that eGFR,serum albumin and C-reactive protein had non-linear relationships with CIN risk.Conclusion Heart failure,diabetes,increased dosage,eGFR stage 3,albumin<38.2 g/L and C-reactive protein>11.4 mg/L were the risk factors of iodixanol-induced CIN in elderly patients.Clinicians should evaluate the risk factors when using iodixanol.

关 键 词：碘克沙醇 对比剂肾病 肾小球滤过率 

分 类 号：R969[医药卫生—药理学]