评价对比剂肾病患者继发终末期肾脏病的风险模型及应用性研究

摘要

目的 搜集与对比剂肾病(CIN)相关的临床指标,构建评判该患者继发终末期肾脏病(ESRD)的风险性模型,并验证其应用性.方法 连续性纳入CIN患者为研究队列,分析研究对象初始入院时的各项临床资料及实验室检查结果,并对其进行为期18个月的随访以确认预后,依据随访结果,进行远期风险性预测和相关危重度评判分析.结果 本次研究纳入215例CIN患者,14例失访,19例随访期内进展至ESRD.Cox回归分析显示,近期重复接受造影、高MRS量表评分、高尿肾损伤分子一1(uKIM-1)含量、高尿微量蛋白(umAlb)含量、高尿中性粒细胞明胶酶相关脂质运载蛋白(uN-GAL)含量为CIN患者发病18个月内继发ESRD的独立危险因素.以umAlb=36.80 ng/ml、uNGAL=128.21 ng/ml、uKIM-1=137.56 pg/ml为临界值预测CIN患者进展至ESRD的ROC曲线下面积分别为0.746、0.756、0.768.结论 本研究建立CIN患者继发ESRD的风险预测模型,并对相关危险因素进行了量化,进一步完善了CIN的诊疗体系.%Objective To evaluate the risk model of patients with secondary end stage renal disease (ESRD),and to validate its applicability by collecting clinical parameters of contrast induced nephropathy (CIN).Methods CIN patients were continuously enrolled in the study.The clinical data and laboratory results were analyzed.Eighteen months follow-up was performed for CIN patients to confirm the prognosis,and the long-term risk prediction and related risk assessment were analyzed based on the follow-up results.Results Totally 215 cases of CIN patients were included in the study.Among them,14 patients were lost in follow-up,and 19 patients progressed to ESRD stage during follow-up period.Cox regression analysis showed that the risk factors of poor prognosis in CIN patients included repeated angiography,high MRS scale score,high uKIM-1 level,high umAlb level and high uNGAL level.All of these factors were independent risk factors of ESRD within 18 months in CIN patients.Taking umAlb=36.80 ng/ml,uNGAL=128.21 ng/ml,uKIM-1=137.56 pg/ml as threshold,the areas under ROC curve were 0.746,0.756 and 0.768 respectively.Conclusion In this study,the risk factors of ESRD in CIN patients were predicted and quantified,and the CIN diagnosis and treatment system were further improved.