摘要
目的探讨缺血性脑卒中(IS)患者数字减影血管造影(DSA)后发生造影剂后急性肾损伤(PS-AKI)的危险因素,并构建风险预测模型。方法选取2018年3月至2023年3月成都市第三人民医院收治的325例接受DSA的IS患者,男性205例,女性120例,年龄(53.79±11.64)岁,年龄范围为42~75岁。统计患者PS-AKI的发生情况,收集患者的一般资料、实验室指标及造影相关指标。采用二元logistic回归分析筛选IS患者DSA后发生PS-AKI的危险因素,构建列线图模型。结果325例IS患者中,共计21例患者发生PS-AKI,PS-AKI发生率为6.5%(21/325)。发生PS-AKI与未发生PS-AKI患者贫血、慢性肾病、甘露醇治疗患者比例、白细胞计数、血红蛋白、尿酸、白蛋白、血清肌酐、肌酐清除率、血尿素氮、超敏C反应蛋白、尿蛋白水平、造影剂剂量、造影操作时间比较,差异有统计学意义(P<0.05)。logistic回归分析显示,有慢性肾病史、使用甘露醇、高白细胞计数及高造影剂用量是患者发生PS-AKI的独立危险因素(P<0.05)。Hosmer-Lemeshow检验显示,预测模型的拟合优度好(P=0.159)。预测模型的受试者工作特征曲线下面积为0.812(95%CI:0.719~0.877,P<0.05)。校准曲线显示模型的区分度和准确性良好。结论慢性肾病、甘露醇使用、高白细胞计数及高造影剂用量是IS患者DSA后发生PS-AKI的独立危险因素,构建的风险预测模型可有效预测早期PS-AKI的发生。
Objective To explore the risk factors for post-contrast acute kidney injury(PS-AKI)after digital subtraction angiography(DSA)in patients with ischemic stroke(IS)and to construct a risk prediction model.Methods A total of 325 IS patients who underwent DSA from March 2018 to March 2023 were selected as the research objects.There were 205 males and 120 females,aged(53.79±11.64)years old,with an age range of 42 to 75 years old.The occurrence of PS-AKI were calculated,and general data,laboratory indicators,and imaging related indicators were collected.Binary logistic regression analysis was used to screen risk factors and construct a nomogram model.Results Among the 325 IS patients,21 patients had PS-AKI,with an incidence rate of 6.5%(21/325).There were statistically significant differences in anemia,chronic kidney disease,mannitol use,white blood cell(WBC)counts,uric acid,serum creatinine,blood urea nitrogen,high-sensitivity C-reactive protein,positive urinary protein,contrast agent dose and the number of cases with contrast operation time>30 min,haemoglobin,albumin and creatinine clearance rate between PS-AKI and non-PS-AKI patients(P<0.05).Logistic regression analysis showed that chronic kidney disease history,mannitol use,raised WBC and large contrast agent dosage were independent risk factors for PS-AKI in patients(P<0.05).Hosmer-Lemeshow test showed that prediction model had a good fit(P=0.159).The area under the receiver operating characteristic curve of the prediction model was 0.812(95%CI:0.719-0.877,P<0.05).The calibration curve showed that the prediction model had good discrimination and accuracy.Conclusion Chronic kidney disease,mannitol use,raised WBC and large contrast agent dosage are independent risk factors for PS-AKI after DSA in IS patients.The constructed risk prediction model can effectively predict the occurrence of early PS-AKI.
作者
陈清燕
陈晓玉
黄小凤
刘艳
周咏梅
CHEN Qing-yan;CHEN Xiao-yu;HUANG Xiao-feng;LIU Yan;ZHOU Yong-mei(Department of Neurology,Third People's Hospital of Chengdu,Chengdu 610014,China)
出处
《创伤与急危重病医学》
2025年第3期204-209,215,共7页
Trauma and Critical Care Medicine
基金
成都市科技项目(2019-YF09-00120-SN)。
