介入诊疗诱发对比剂肾病的发生率、危险因素及预后研究

发布时间：2018-06-21 18:05

本文选题：对比剂肾病 + 胱抑素C　；参考：《中南大学》2012年硕士论文

【摘要】：背景：目前国际上主要采用欧洲泌尿放射学会(ESUR)和改善全球肾脏病预后组织(KDIGO)制定的标准来评价对比剂肾病(CIN),但究竟哪种标准更适合临床,缺乏前瞻性研究。在早期预测CIN方面,血清胱抑素C (CysC)是否优于血清肌酐(Scr)尚有争议。目的：应用血清CysC标准和Scr标准评价住院患者行介入诊疗操作后CIN的发生率、危险因素及预后；比较血清CysC和Scr在CIN诊断中的敏感性和特异性。方法：选择2011年4月—10月在湘雅二医院血管介入病区行血管造影或(和)介入治疗且符合入选标准的患者213例。分别应用血清CysC标准和Scr标准对入选病例进行评价。结果： 1.CIN的发生率为4.2%～24.4%。 2.慢性肾脏病、高胆固醇血症、糖尿病、脱水、低蛋白血症是CIN发生的独立危险因素。 3. ESUR标准ROC曲线比较发现造影后48h Scr与血清CysC的曲线下面积无明显差异(0.790vs0.715,p=0.178)；KDIGO标准ROC曲线比较发现造影后48h Scr水平比CysC水平有更好的曲线下面积(0.972vs0.856,p=0.006)。 4. ESUR和KDIGO标准诊断的CIN组死亡率均分别高于非CIN组(p0.05),但是血清CysC标准诊断的CIN组死亡率与非CIN组的比较无统计学意义(p0.05)。结论： CIN的发生率与诊断标准的选择有关；血清CysC标准对介入诊疗患者CIN的诊断并不优于血清肌酐标准；对于介入诊疗患者,采用ESUR标准作为CIN的诊断标准可能更适合临床；慢性肾脏病、糖尿病、高胆固醇血症、脱水、低蛋白血症是介入诊断和治疗患者CIN发生的独立危险因素；CIN是介入诊疗患者造影后3个月内死亡相关的原因之一。
[Abstract]:Background: at present, the European Society of Urology and Radiology (ESURS) and KDIGO (the Global Organization for the prognosis of Kidney Disease) are mainly used to evaluate the contrast agent nephropathy, but which standard is more suitable for clinical application and is lack of prospective research. Whether serum cystatin C (CysC) is superior to serum creatinine (SCR) in early prediction of cin is controversial. Objective: to evaluate the incidence, risk factors and prognosis of cin after interventional therapy in inpatients with CysC and SCR, and to compare the sensitivity and specificity of serum CysC and SCR in the diagnosis of cin. Methods: 213 patients who received angiography or / and interventional therapy from April to October 2011 in Xiangya No.2 Hospital were selected. Serum CysC criteria and SCR criteria were used to evaluate the selected cases. Results: 1. The incidence of cin was 4. 2 and 24. 42. Chronic kidney disease, hypercholesterolemia, diabetes, dehydration and hypoproteinemia are independent risk factors for cin. There was no significant difference in the area under the curve between SCR and serum CysC at 48h after angiography. The area under the curve was better than that of CysC at 48h after angiography. The area under the curve was 0.972vs0.856p0.0060.The area under the curve was 0.972vs0.856p0.0064.The area under the curve was 0.972vs0.856p0.006. The mortality rate of cin group diagnosed by er and KDIGO was higher than that of non-CIN group, but the mortality rate of cin group diagnosed by serum CysC standard was not significantly higher than that of non-CIN group. Conclusion: the incidence of cin is related to the choice of diagnostic criteria, serum CysC standard is not superior to serum creatinine standard in the diagnosis of cin in interventional patients. Esur criteria may be more suitable for diagnosis of cin, chronic kidney disease, diabetes, hypercholesterolemia, dehydration, hypoproteinemia are independent risk factors of cin in patients with interventional diagnosis and treatment. Cin is one of the related causes of death within 3 months after interventional radiography.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.2;R692.9

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