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Radiology:住院患儿静脉注射碘造影剂真的有那么可怕吗?

2021-05-05 shaosai MedSci原创

在儿童CT检查中,通常静脉给予低渗和等渗碘造影剂(ICM)以增强血管、脏器和病变的对比度。

儿童CT检查中,通常静脉给予低渗和等渗碘造影剂(ICM)以增强血管、脏器和病变的对比度。通常定义血管内ICM暴露后48小时内出现的急性肾损伤(AKI)为直接由ICM引起的造影剂肾病。然而在过去的十年中,造影剂肾病的现象受到了质疑,大多数有关造影剂肾病相关研究均没有包括未暴露于ICM的对照组患者。此外,相关性并不意味着因果关系,还有许多与肾灌注减少、直接肾毒性暴露、内源性肾脏疾病和尿路阻塞相关的造影剂后AKI (PC-AKI)危险因素会混淆AKI的观察结果。迄今为止,使用倾向评分匹配来确定ICM暴露与住院儿科患者发生AKI之间的关联的文献十分稀少。

近日,发表在Radiology杂志的一项研究通过与倾向评分匹配的未暴露ICM的进行腹部超声检查的患者样本进行比较通过比较接受腹部超声检查的倾向评分匹配未暴露ICM的患者样本,评估肾功能稳定的住院儿童患者静脉ICM暴露与PC-AKI之间的关系,为临床进一步规范化儿科患者的检查流程提供了参考依据。

本项回顾性观察研究的研究对象为2009年1月至2018年11月间接受静脉ICM或腹部超声检查的18岁或以下、肾功能稳定、具有成像前后血清肌酐(SCr)测定的住院患者以及接受腹部超声检查的住院患者(对照组)。1:1倾向评分匹配采用23个协变量,在成像前通过估计肾小球滤过率(eGFR)进行分层(≥60 mL/min/1.73 m2或<60 mL/min/1.73 m2)。AKI采用急性肾损伤网络SCr相关标准定义。采用多变量logistic回归分析确定成像后AKI的危险因素,包括成像前eGFR和静脉ICM暴露的影响。

本研究共纳入1850例患者进入倾向评分匹配样本(925例暴露于ICM[平均年龄±标准差,8岁±6岁;484名女性患者;925例未暴露于ICM[平均年龄,7岁±6岁;484名女性患者])。CT和US检查显示,eGFR大于或等于60 mL/min/1.73 m2的AKI发生率为2.2%(20/889)(比值比[OR]: 0.98;95%置信区间[CI]: 0.52, 1.86;调整后P = .95),eGFR小于60 mL/min/1.73 m2的的AKI发生率在CT和US中分别为5.6%(36例中2例)和11.1%(36例中4例)(OR: 0.75;95% CI: 0.11, 5.00;调整后的P = .76)。AKI的重要多变量预测因素包括成像前eGFR (OR: 0.99;95% CI: 0.98, 0.995;P = .001)、体重指数(OR: 1.06;95% CI: 1.02、1.10;P = .003)、获得性肾病(OR: 1.95;95% CI: 1.004、3.78;P = .049)以及肾毒性抗生素暴露(OR: 2.86;95% CI: 1.55、5.25;P <.001)。静脉注射ICM暴露不具有预测性(OR: 0.91;95% CI: 0.51、1.64;P > . 05)。

 

表1 在1:1倾向评分匹配的人群中成像后急性肾损伤预测因子的单变量Logistic回归分析。

本研究表明,与未暴露于碘造影剂(ICM)的倾向评分匹配的腹部超声检查的儿童患者样本相比,接受增强CT成像的肾功能稳定的住院儿童患者急性肾损伤(AKI)的频率相当。本研究发现,强化后AKI (PC- AKI)的总频率为2.4%。在肾功能正常或轻度下降(肾小球滤过率估计≥60 mL/ min/1.73 m2)的住院患儿中,静脉ICM暴露与PC-AKI并非独立相关。

原文出处:

Leah A Gilligan,Matthew S Davenport,Andrew T Troutet al.Risk of Acute Kidney Injury Following Contrast-enhanced CT in Hospitalized Pediatric Patients: A Propensity Score Analysis.DOI:10.1148/radiol.2020191931

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    2021-12-18 fusion
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    2021-05-07 sodoo
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