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目的为了确定静脉注射碘对比剂对于急性肾损伤(AKI)也被称为对比剂肾病(CIN)发病率的因果关系和效应。材料与方法这项回顾性研究获得机构伦理委员会批准,并遵从HIPAA法案。免除知情同意书。从2000年—2010年,所有对比剂增强(对比剂组)和平扫(非对比剂组)的腹部、盆腔、胸部CT扫描都是由单一设备进行的。通过血清肌酐(SCr)水平将这些被扫描的病人分成3个假定会发生CIN的风险组,分别为低(<1.5mg/dL)、中(1.5~2.0mg/dL)和高风险(>2.0mg/dL)组。AKI的发病率(SCr≥基线以上0.5mg/dL,1dL=100mL)通过分层法倾向评分调整后在增强组和平扫组之间进行对比,通过1∶1匹配、倒数加权和加权的概率方法来减少组间选择偏离。利用McNemar检验评估在研究期间做过增强CT和平扫CT的病人,反事实分析方法被用来评估对比剂与AKI之间的因果关系。结果 53439例病人总共进行了157140次扫描,并得到1510001个SCr值。应用报告的CIN的危险因素[低风险:比值比(OR),0.93;95%CI:0.76~1.13;P=0.47;中度风险:OR,0.97;95%CI:0.81~1.16;P=0.76;高风险:OR,0.91;95%CI:0.66~1.24;P=0.58],在倾向评分调整后,AKI的风险在对比剂组和非对比剂组间无显著差异。反事实分析表明对于同一个病人来说,AKI的发病率在增强与非增强CT扫描中亦无显著差异(McNemar检验:χ2=0.63,P=0.43)(OR=0.92;95%CI:0.75~1.13;P=0.46)。结论随着假定风险因素的调整,CIN的发病率与非对比剂导致的AKI的发病率没有明显差异。这两种现象在临床上用SCr定义的标准是不能区分的,提示静脉注射碘对比剂可能不是导致肾功能下降的致病因素。
Purpose To determine the causal relationship and effect of IV contrast agents for acute kidney injury (AKI), also known as contrast nephropathy (CIN) incidence. Materials and Methods This retrospective study was approved by the Institutional Ethics Committee and complied with the HIPAA Act. Exemption from informed consent. From 2000 to 2010, all contrast-enhanced (contrast) and plain (non-contrast) groups of abdominal, pelvic and chest CT scans were performed on a single device. The patients screened were divided into three risk groups assuming CIN by serum creatinine (SCr) levels: low (<1.5 mg / dL), moderate (1.5-2.0 mg / dL) and high risk mg / dL) group. The incidence of AKI (SCr ≥ 0.5 mg / dL above baseline, 1 dL = 100 mL) was adjusted by stratification propensity score comparison between enhancement and plain scan groups using a 1: 1 match, reciprocal weighting and weighted probabilistic approach To reduce the choice between groups deviation. Anti-factual analysis was used to assess the causal relationship between contrast agents and AKI using McNemar’s test in patients who underwent enhanced CT and plain CT scan during the study. Results 53439 patients performed a total of 157140 scans and obtained 1510001 SCr values. Risk factors for the reported CIN [low risk: odds ratio (OR), 0.93; 95% CI: 0.76 to 1.13; P = 0.47; moderate risk: OR, 0.97; 95% CI: 0.81 to 1.16; ; High risk: OR, 0.91; 95% CI: 0.66-1.24; P = 0.58]. There was no significant difference in the risk of AKI between the comparator and non-comparator groups after the propensity score was adjusted. Counterfactual analysis showed that there was no significant difference in the incidence of AKI between the enhanced and non-enhanced CT scans in the same patient (McNemar test: χ2 = 0.63, P = 0.43) (OR = 0.92; 95% CI: 1.13; P = 0.46). Conclusions With the adjustment of risk factors, the incidence of CIN was not significantly different from that of non-contrast-induced AKI. These two phenomena are clinically indistinguishable from the criteria defined by SCr, suggesting that intravenous administration of iodine contrast agents may not be a causative agent of decreased renal function.