CAJ | 학술논문

目的探讨静脉注射碘对比剂对不同疾病人群肾功能的影响.方法前瞻性分析1243例(男694例、女549例)患者静脉注射碘对比剂前及注射后72 h内血清肌酐变化,按照年龄、性别、体质量指数、高血压、糖尿病、慢性肾病、慢性心功能不全、恶性肿瘤病史、使用肾毒性药物、对比剂类型及剂量、一个月内使用对比剂次数及注射流率分别分组,比较各组对比剂肾病(CIN)发病率.采用Logistic回归分析方法预测CIN风险因素,以P＜0.10为标准,计算自变量优势比(OR值)及95％置信区间.结果 CIN的总发生率为5.5％ (68/1243),其中无慢性病人群为4.5％(17/375),患有糖尿病、慢性肾病、慢性心功能不全、高血压或恶性肿瘤患者为5.9％ (51/868).慢性肾病患者发病率为4.4％(9/203),无慢性肾病患者发病率为5.7％ (59/1040),差异无统计学意义(x2=0.51,P =0.30).慢性肾病患者中,年龄、性别、体质量指数、高血压、糖尿病、慢性心功能不全、恶性肿瘤病史、使用肾毒性药物、对比剂类型及剂量、一个月内对比剂使用次数及注射流率等组间的CIN发病率差异无统计学意义(P＞0.05).无慢性肾病患者中,女性患者、糖尿病及使用低渗性对比剂患者CIN发病率高于对照组(P＜0.05).女性、高龄(≥75岁)、糖尿病、使用低渗性对比剂、肾毒性药物、恶性肿瘤及一个月内使用对比剂次数≥2次共7个风险因素OR值＞1.结论女性、高龄、糖尿病、使用低渗对比剂、使用肾毒性药物、恶性肿瘤病史、1个月内对比剂使用≥2次可能是CIN发生的独立风险因素.
목적 탐토정맥주사전대비제대불동질병인군신공능적영향.방법 전첨성분석1243례(남694례、녀549례)환자정맥주사전대비제전급주사후72 h내혈청기항변화,안조년령、성별、체질량지수、고혈압、당뇨병、만성신병、만성심공능불전、악성종류병사、사용신독성약물、대비제류형급제량、일개월내사용대비제차수급주사류솔분별분조,비교각조대비제신병(CIN)발병솔.채용Logistic회귀분석방법예측CIN풍험인소,이P＜0.10위표준,계산자변량우세비(OR치)급95％치신구간.결과 CIN적총발생솔위5.5％ (68/1243),기중무만성병인군위4.5％(17/375),환유당뇨병、만성신병、만성심공능불전、고혈압혹악성종류환자위5.9％ (51/868).만성신병환자발병솔위4.4％(9/203),무만성신병환자발병솔위5.7％ (59/1040),차이무통계학의의(x2=0.51,P =0.30).만성신병환자중,년령、성별、체질량지수、고혈압、당뇨병、만성심공능불전、악성종류병사、사용신독성약물、대비제류형급제량、일개월내대비제사용차수급주사류솔등조간적CIN발병솔차이무통계학의의(P＞0.05).무만성신병환자중,녀성환자、당뇨병급사용저삼성대비제환자CIN발병솔고우대조조(P＜0.05).녀성、고령(≥75세)、당뇨병、사용저삼성대비제、신독성약물、악성종류급일개월내사용대비제차수≥2차공7개풍험인소OR치＞1.결론 녀성、고령、당뇨병、사용저삼대비제、사용신독성약물、악성종류병사、1개월내대비제사용≥2차가능시CIN발생적독립풍험인소.
Objective To investigate the incidence of contrast induced nephropathy (CIN) among different patient groups after contrast agent injection.Methods A total of 1243 patients were included in this study (male =694,female =549).The SCr level one week before and 72 hours after the CT examination and the incidence of CIN were recorded and comparison was made among groups according to sex,age,body mass index (BMI),the history of high blood pressure (HBP),diabetes mellitus (DM),chronic kidney disease (CKD),chronic heart failure (CHF),tumor,nephrotoxicity drug (NTD) usage.The frequency,type,dose and injection velocity of the contrast media(CM)were also recorded.Multivariate predictors of CIN were identified by Logistic regression using step-wise selection with entry and exit criteria of P ＜0.10,results were tabulated as odds ratios (OR) with 95％ confidence intervals (CI).Results Among 1243 consecutive patients,the incidence of CIN was 5.5％ (68/1243).Patients with a history of HBP,DM,CHF,CKD or tumor presented with higher incidence of CIN than that of controls (5.9％,51/868 vs.4.5％,17/375).CIN developed in 9 of 203 patients (4.4％,9/203) with CKD and in 59 of 1040 patients (5.7％,59/1040)without CKD.There was no significant difference between the two groups(x2 =0.51,P =0.30).In CKD (-) group,the incidence of CIN was higher in females,patients with DM and patients using LOCM than those of males,DM (-) and using low osmolality contrast medium (IOCM) (P ＜ 0.05),but there was no statistical significance in CKD (+) group.Logistic regression analysis showed that women,age ≥ 75 years,DM,LOCM,NTD,tumor,the time of using CM more than once per month were the most significant predictors of CIN (OR ＞ 1).Conclusion Women,age ≥ 75 years,LOCM,NTD,tumor,and the frequency of using CM more than once per month were more likely to develop CIN.