目的 探讨碘总量(gram-iodine,g-I)与绝对肾小球滤过率(absolute glomerular filtration rate,GFRABS)比值(g-I/GFRABS)对慢性肾脏病(chronic kidney disease,CKD)患者发生对比剂诱导的急性肾损伤(contrast medium-induced acute kidney injury,CI-AKI)的预测价值。 方法 采用回顾性分析，选取2023年1月─3月在新疆医科大学第一附属医院接受静脉注射对比剂检查的CKD患者，收集其临床资料并计算g-I/GFRABS。根据检查后7 d内是否发生CI-AKI将患者分为CI-AKI组与非CI-AKI组。采用多因素Logistic回归法分析CI-AKI的独立危险因素并绘制受试者工作特征曲线分析相关比值对CI-AKI的预测效能。 结果 共纳入221例CKD患者，其中CI-AKI组28例，非CI-AKI组193例。与非CI-AKI组相比，CI-AKI组基线血清肌酐、尿素氮、尿酸水平及对比剂体积(contrast medium volume,CMV)与估算肾小球滤过率(estimated glomerular filtration rate,eGFR)比值(CMV/eGFR)、g-I/GFRABS、g-I/eGFR均显著升高(t=-4.212、-4.028、-2.984、-3.821、-4.816、 -3.709，P＜0.001、＜0.001、0.003、＜0.001、＜0.001、＜0.001)。而eGFR、GFRABS、血红蛋白、红细胞比容水平均显著降低(t=5.644、5.233、2.826、2.966，P＜0.001、＜0.001、0.005、0.003)。多因素Logistic回归分析显示，高CMV/eGFR(OR=4.574、95%CI：2.197～9.520、P＜0.001)、高g-I/GFRABS(OR=23.671、95%CI：3.287～170.449、P=0.002)、高g-I/eGFR(OR=22.345、95%CI：4.617～108.134、P＜0.001)是CKD患者发生CI-AKI的独立危险因素，而基线血清肌酐、尿素氮、尿酸的影响因模型不同而异。受试者工作特征曲线分析显示g-I/GFRABS预测CI-AKI发生的曲线下面积为0.781(95% CI：0.668～0.893)，最佳截断值为0.926，敏感度为60.7%，特异度为96.4%。 结论 g-I/GFRABS是CKD患者发生CI-AKI的独立危险因素，可作为识别高危人群的参考指标。
Abstract
Objective To investigate the predictive value of the gram-iodine/absolute glomerular filtration rate ratio (g-I/GFRABS) for contrast-induced acute kidney injury (CI-AKI) in patients with chronic kidney disease (CKD) undergoing intravenous contrast medium administration. Methods This retrospective study enrolled CKD patients who underwent intravenous contrast medium examinations administration at the First Affiliated Hospital of Xinjiang Medical University from January to March 2023. Clinical data were collected, and the g-I/GFRABS was calculated. Patients were divided into CI-AKI group and non-CI-AKI group based on the occurrence of CI-AKI within 7 days post-procedure. Multivariate Logistic regression analysis was used to identify independent risk factors for CI-AKI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of relevant ratios for CI-AKI. Results A total of 221 CKD patients were included, with 28 in the CI-AKI group and 193 in the non-CI-AKI group. Compared with the non-CI-AKI group, the CI-AKI group had significantly higher baseline levels of serum creatinine, blood urea nitrogen, and uric acid, as well as higher values of the ratio of contrast medium volume to estimated glomerular filtration rate ratio (CMV/eGFR), g-I/GFRABS, and g-I/eGFR (t=-4.212, -4.028, -2.984, -3.821, -4.816, -3.709, respectively; all P ＜ 0.001 except for uric acid, where P=0.003). Conversely, levels of eGFR, GFRABS, hemoglobin, and hematocrit were significantly lower in the CI-AKI group (t=5.644, 5.233, 2.826, 2.966, respectively; all P＜0.001 except for hemoglobin, P=0.005 and hematocrit, P=0.003). Multivariate Logistic regression analysis revealed that high CMV/eGFR (OR=4.574, 95% CI:2.197～9.520, P＜0.001), high g-I/GFRABS (OR=23.671, 95% CI:3.287～170.449, P=0.002), and high g-I/eGFR (OR=22.345, 95% CI: 4.617～108.134, P＜0.001) were independent risk factors for CI-AKI in CKD patients. The influence of baseline serum creatinine, blood urea nitrogen, and uric acid on CI-AKI varied depending on the model. ROC curve analysis showed that the area under the curve for g-I/GFRABS in predicting CI-AKI was 0.781 (95% CI: 0.668～0.893), with an optimal cut-off value of 0.926, yielding a sensitivity of 60.7% and a specificity of 96.4%. Conclusion The g-I/GFRABS is an independent predictor of CI-AKI in CKD patients and may serve as a useful indicator for identifying high-risk individuals.
关键词
急性肾损伤 /
对比剂 /
慢性肾脏病 /
肾小球滤过率
Key words
Acute kidney injury /
Contrast medium /
Chronic kidney disease /
Glomerular filtration rate
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基金
“天山英才”医药卫生高层次人才培养计划(TSYC202301B012)；新疆维吾尔自治区重大科技专项项目(2022A03001-2)
