经导管动脉内化疗栓塞术后急性肾损伤影响因素与预后分析

Risk factors and prognosis of acute kidney injury following transarterial chemoembolization in patients with hepatocellular carcinoma

目的经导管动脉内化疗栓塞（TACE）是原位进展期肝细胞肝癌（HCC）的一线治疗手段。但操作过程中使用的造影剂可引起术后急性肾损伤,但其发生率、危险因素及预后仍不明确,本研究目的在于评价TACE术后急性肾功能不全（AKI）的发生率、危险因素及对患者预后的影响。方法这项前瞻性研究纳入连续130例患者共245次TACE操作,根据两种不同标准评价TACE术后AKI发生情况,通过组间比较评价了TACE术后AKI的发生率、危险因素及预后等。结果按照Barrett＆Parfrey的标准TACE术后AKI的发生率为18.37%（45/245）,按照AKIN的标准TACE术后AKI的发生率为5.71%（14/245）。多因素Logistic回归分析发现,按照Barrett＆Parfrey的标准,PT-INR〉1.05是发生TACE术后AKI的独立危险因素;而按照AKIN的标准,既往TACE术后AKI病史是在此发生TACE术后AKI的独立危险因素。在预后方面,按照AKIN的标准发生TACE术后AKI者中有2例（14.29%,P=0.006）接受了连续性肾脏替代治疗,2例（14.29%,P=0.006）残留慢性肾功能不全。无论参照哪种标准,发生TACE术后AKI者与未发生者住院日期、总住院费用及术后30 d死亡率等均未见显著差异。结论本研究发现,根据不同评价标准,TACE术后AKI发生率约为5.71%～18.37%。PT-INR（〉1.05）及既往TACE术后AKI病史是发生TACE术后AKI的独立危险因素。按照AKIN的标准,发生TACE术后AKI的患者肾脏替代治疗及发生慢性肾功能不全的风险更高。

Objective Transcatheter arterial chemoembolization（TACE） is an effective first-line therapy for intermediate stage hepatocellular carcinoma（HCC）.Acute renal injury may be induced after TACE because of iodinated radiocontrast medium,but its incidence,risk factors and prognosis remains unclear.This study aims to evaluate post？ TACE acute kidney injury（ AKI） incidence,risk factors and prognosis in HCC patients.Methods This prospective study enrolled 130 HCC patients with a total of 245 TACE treatments.The occurrence of AKI was evaluated according to two kinds of standards.The incidence,risk factors and prognosis of AKI were examined.Results The incidence of post-TACE AKI was 18.37%（45/245） according to Barrett Parfrey criterion,while 5.71%（14/245） according to AKIN criterion.Multivariate logistic regression analysis showed that PT-INR〉1.05 was associated with the development of AKI after TACE procedure according to Barrett Parfrey criterion.While post-TACE AKI history was associated with the development of AKI after TACE procedure according to AKIN criteria.For AKIN criteria,2（14.29%） patients developed chronic renal insufficiency（ P = 0.006）,whereas 2（14.29%） received continuous veno-venous hemofiltration treatment according to the physician＇ s decision（P=0.006）.No significant difference in hospital stay,total hospitalization cost and mortality existed between patients with or without TACE AKI whatever the definition used.Conclusion The incidence of post-TACE AKI is high in HCC patients,ranging between 5.71% and 18.37%,depending on the criteria used.PT-INR（〉1.05） and post-TACE AKI history may be predictors of post-TACE AKI in HCC patients.The development of post-TACE AKI is associated with risk of renal replacement treatment and prolonged renal insufficiency according to AKIN criterion.