肾阻力指数评估肺动脉高压患者CTPA检查后对比剂肾病发生风险的研究

Risk of contrast-induced nephropathy reviewed with renal resistance index in patients with pulmonary arterial hypertension after computed tomographic pulmonary angiography

目的研究肾阻力指数(RRI)评估肺动脉高压(PAH)患者行CT肺动脉造影(CTPA)检查后对比剂肾病(CIN)发生的风险。方法本研究纳入2018年9月至2019年12月于河北医科大学第二医院及秦皇岛市海港医院心内科诊断为PAH的患者为研究对象,入院后均行CTPA检查。于CTPA检查前1 h、检查后1 h和24 h行肾脏多普勒超声检测RRI;患者入院时、CTPA检查后24 h、48 h、72 h分别检测血清肌酐(SCr)、估测肾小球滤过率(eGFR)。CTPA检查后72 h,依据患者是否发生CIN,将患者分为CIN组(n=10)和无CIN组(n=93)。对两组患者血清SCr、eGFR及RRI分别进行比较。应用受试者工作特征(ROC)曲线分析,确定RRI预测CIN的敏感性及特异性。结果入选的103例PAH患者中10例发生CIN,发生率为9.71%。CIN组与无CIN组患者入院时血清SCr及eGFR无明显差异(P>0.05)。在CTPA检查后24 h、48 h、72 h时CIN组血清SCr水平均显著高于无CIN组(P<0.05)。在CTPA检查后72 h,CIN组eGFR水平低于无CIN组(P<0.05)。CTPA检查前1 h,两组RRI水平差异无统计学意义(P>0.05);CTPA检查后1 h及24 h,CIN组RRI水平均高于无CIN组(P<0.05)。ROC曲线下面积在CTPA检查前1h、检查后1 h及24 h分别为0.563、0.821及0.698,95%置信区间分别为[(0.416~0.710),P>0.05]、[(0.689~0.953),P<0.01]及[(0.552~0.845),P<0.05]。以RRI≥0.69为截点,CTPA检查前1 h、检查后1 h及24 h RRI预测CIN敏感性分别为:10.0%、70.0%、40.0%;特异性分别为:83.9%、76.3%、78.5%。结论PAH患者行CTPA检查应用对比剂(CM)后RRI水平波动性变化可提示CIN的发生、发展;RRI可作为预测PAH患者CTPA检查后CIN发生的有用指标。

Objective To study the risk of contrast-induced nephropathy(CIN)reviewed with renal resistance index(RRI)in patients with pulmonary arterial hypertension(PAH)after computed tomographic pulmonary angiography(CTPA).Methods PAH patients were chosen from Departments of Cardiology in the Second Hospital of Hebei Medical University and Haigang Hospital of Qinhuangdao City from Sept.2018 to Dec.2019,and all patients were undergone CTPA examination.RRI was detected by using renal Doppler ultrasonography 1 h before CTPA and 1 h and 24 h after CTPA.The levels of serum creatinine(SCr)and estimated glomerular filtration rate(eGFR)were detected at admission time and 24 h,48 h and 72 h after CTPA.After CTPA for 72 h,all patients were divided into CIN group(n=10)and non-CIN group(n=93)according to whether patients had CIN or not.The indexes of SCr,eGFR and RRI were compared between 2 groups.The sensitivity and specificity of RRI for predicting CIN were determined by using receiver operating characteristic(ROC)curve.Results There were 10 cases of CIN among 103 PAH patients and CIN incidence rate was 9.71%.SCr and eGFR had no significant difference between CIN group and non-CIN group at admission time(P>0.05).SCr was significantly higher in CIN than that in non-CIN group 24 h,48 h and 72 h after CTPA(P<0.05),and eGFR was lower in CIN than that in non-CIN group 72 h after CTPA(P<0.05).The difference in RRI level had no statistical significance between 2 groups 1 h before CTPA(P>0.05),and RRI level was higher in CIN than that in non-CIN group 1 h and 24 h after CTPA(P<0.05).The area under ROC curve of RRI was 0.563,0.821 and 0.698,respectively,1 h before CTPA and 1 h and 24 h after CTPA(95%CI:0.416~0.710,P>0.05;95%CI:0.689~0.953,P<0.01;95%CI:0.552~0.845,P<0.05).Taken RRI≥0.69 as the cut-off point,RRI sensitivity in predicting CIN was,respectively,10.0%,70.0%and 40.0%,and specificity was,respectively,83.9%,76.3%and 78.5%1 h before CTPA and 1 h and 24 h after CTPA.Conclusion The changes of RRI level can indicate CIN incidence in PAH patients after contrast application during CTPA,and RRI can be taken as a useful indicator to predict CIN incidence in PAH patients after CTPA.