摘要
目的:研究短期内两次注射CT和MR对比剂增强扫描对肾功能的影响.方法:回顾性收集2020年1月—2022年5月在本院行CT和MR增强扫描的住院病例,检查时间在两周以内.另收集同期在本院行单独CT或单独MR增强检查的住院病例.采集住院病例资料中的临床信息、增强扫描信息和注射对比剂前后的肾功能信息,包括:性别、年龄、基础疾病、增强检查方式、增强检查时间、增强前1周以内的基础血肌酐值、增强后48～72小时的血肌酐值等.根据基础血肌酐与增强后48～72小时血肌酐的变化,将患者分为急性对比剂肾损害(CI-AKI)组和non-CI-AKI组.计算CI-AKI的发生率,并比较CI-AKI组与non-CI-AKI组之间临床信息、增强扫描信息的差异.以临床信息、增强扫描信息和注射对比剂前的肾功能信息作为自变量,拟合多因素logistic回归模型,研究CI-AKI的影响因素.结果:共收集649位患者的信息,包括:212位患者行单次CT增强检查;165位患者行单次MR增强检查;272位患者在两周之内行CT和MR共两次增强检查,两次增强检查中位间隔时间为45.8(21.4,96.6)小时.649例患者中有15例发生CI-AKI,发生率为5.5％(95％CI:0.032～0.091).在CI-AKI组和non-CI-AKI组,患者的年龄、性别、身高、体重、基础疾病史、基础肾功能的差异均无统计学意义(P＜0.05).单次增强、短期内两次增强者CI-AKI发生率的差异无统计学意义(P＞0.05).多因素logistic回归分析显示糖尿病、高血压和基础血肌酐值是CI-AKI的影响因素(P＜0.05)o短期内行两次CT和MR增强与单次增强相比,不增加CI-AKI的风险.结论:高血压和基础血肌酐值是发生CI-AKI的影响因素,而短期内行CT和MR增强与单次增强相比不增加CI-AKI的发生.
Abstract
Objective:To investigate the effect on renal function of two short-term consecutive injections of contrast media for CT and MR scans.Methods:A retrospective collection was conducted on inpatient cases who underwent contrast-enhanced CT and MR scans in our hospital from January 2020 to May 2022,with the two examinations performed within a two-week interval.In addition,inpa-tient patients who underwent one CT or MR enhanced scan during the same period were also included.Clinical information,contrast-enhanced scan details,and renal function information before and after contrast injection were collected,including sex,age,primary diseases,type of contrast-enhanced exami-nation,timing of the examination,baseline serum creatinine level within one week before enhance-ment,and serum creatinine level 48～72 hours after enhancement.Patients were divided into a con-trast-induced acute kidney injury(CI-AKI)group and a non-CI-AKI group based on the changes in se-rum creatinine level from baseline to 48～72 hours after contrast injection.The incidence of CI-AKI was calculated,and the differences in clinical information and contrast-enhanced scan details between the CI-AKI group and the non-CI-AKI group were compared.A multivariable logistic regression model was fitted using clinical information,contrast-enhanced scan details,and pre-contrast renal function in-formation as independent variables to investigate the factors influencing CI-AKI.Results:A total of 649 patients'information was collected,including 212 patients who underwent a single CT contrast-en-hanced scan,165 patients who underwent a single MR contrast-enhanced scan,and 272 patients who underwent both CT and MR contrast-enhanced examinations within two weeks,with a median interval of 45.8(21.4,96.6)hours.Among the 649 patients,15 developed CI-AKI,with an incidence rate of 5.5％(95％CI:0.032,0.091).There were no statistically significant differences in age,sex,height,weight,primary disease history,or baseline renal function between the CI-AKI group and the non-CI-AKI group(P＜0.05).There was no statistically significant difference in the incidence of CI-AKI be-tween patients who underwent a single enhancement and those who underwent two consecutive en-hancements in the short term(P＞0.05).Multivariable logistic regression analysis showed that diabe-tes,hypertension,and baseline serum creatinine level were influencing factors for CI-AKI(P＜0.05).The effect of two consecutive contrast-enhanced CT and MR scans in the short term on CI-AKI did not have a statistically significant difference compared with that of single enhancement(P=0.317～0.846).Conclusion:Hypertension and baseline serum creatinine level affect the occurrence of CI-AKI.The effect of two consecutive contrast-enhanced CT and MR scans in the short term on CI-AKI does not have a statistically significant difference compared with that of single enhancement.
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