血红蛋白预测肝癌患者TACE术后对比剂肾病

Hemoglobin in predicting contrast-induced nephropathy in hepatocellular carcinoma patients after TACE

目的评估血红蛋白(Hb)对肝细胞癌(HCC)患者TACE术后发生对比剂肾病(CIN)的预测价值。方法回顾性分析250例原发性HCC患者,共行417次TACE。采用倾向性匹配评分(PSM)法进行配对,以单因素及多因素Logistic回归分析评价CIN发病的危险因素,采用ROC曲线分析Hb水平对CIN的诊断效能。结果PSM匹配前,417次TACE治疗前85次患者出现Hb降低、Hb正常332次;PSM匹配后,74对(即Hb降低、Hb正常分别74次)匹配成功。PSM匹配前,Hb降低时CIN发生率为10.59%(9/85),Hb正常时为4.52%(15/332),糖尿病、Hb、肌酐及胆红素为CIN发病的独立影响因素(P均<0.05)。PSM匹配后,Hb降低时CIN发病率为10.81%(8/74),正常时为4.05%(3/74),Hb为CIN发病的独立影响因素(P<0.05)。ROC曲线结果显示,女性:Hb预测肝癌患者TACE术后发生CIN的最佳截断值为93.5 g/L,诊断灵敏度为91.9%,特异度75.0%,AUC为0.83;男性:Hb预测肝癌患者TACE术后发生CIN的最佳截断值为104.0 g/L,诊断灵敏度为90.8%,特异度36.0%,AUC为0.65。结论Hb是肝癌患者TACE术后发生CIN的独立影响因素。

Objective To assess the value of hemoglobin(Hb)for predicting contrast-induced nephropathy(CIN)in hepatocellular carcinoma(HCC)patients underwent TACE.Methods Totally 250 patients with primary HCC underwent 417 times of TACE were retrospectively analyzed.Patients were matched by using propensity score matching(PSM)method.The risk factors of CIN were assessed with univariate and multivariate Logistic regression analysis.The efficiency of Hb for predicting CIN was evaluated by using ROC analysis.Results Before PSM,there were 85 times with low Hb and 332 times with normal Hb among 417 times of TACE.After PSM,74 pairs(i.e.74 times with low Hb and 74 times with normal Hb)were successfully matched.Before PSM,the incidence of CIN was 10.59%(9/85)in low Hb ones and 4.52%(15/332)of normal Hb ones,diabetes mellitus,Hb,creatinine and bilirubin were independent factors of CIN(all P<0.05).After PSM,the incidence of CIN was 10.81%(8/74)in low Hb ones and 4.05%(3/74)of normal Hb ones,and Hb was an independent predictor of CIN(P<0.05).ROC results showed that the optimal cut-off point of Hb for predicting CIN in female HCC patients following TACE was 93.5 g/L,with a sensitivity of 91.9%and specificity of 75.0%,AUC of 0.83.Hb of 104.0 g/L was determined as the optimal cut-off point for predicting CIN in male HCC patients following TACE,with sensitivity,specificity and AUC of 90.8%,36.0%and 0.65 respectively.Conclusion Hb is an independent risk factor for development of CIN in HCC patients following TACE.