Nyman U, Björk J, Aspelin P, Marenzi G
Department of Radiology, Lasarettet Trelleborg, University of Lund, Trelleborg, Sweden.
Acta Radiol. 2008 Jul;49(6):658-67. doi: 10.1080/02841850802050762.
The contrast medium (CM) dose-to-eGFR (estimated glomerular filtration rate) ratio has recently been advocated to express systemic exposure to CM in assessing the risk of contrast medium-induced nephropathy (CIN).
To evaluate how CIN risk might vary with decreasing eGFR at fixed CM-dose/eGFR ratios and other CIN risk factors, and to find a relatively safe CM-dose/eGFR ratio.
391 patients underwent primary coronary angioplasty for ST-segment elevation acute myocardial infarction. CM dose (grams iodine; g I), eGFR (ml/min), and preprocedural CIN risk factors were entered into a multiple logistic regression model. From the established statistical model, the probability of CIN (>or=44.2 micromol/l serum creatinine rise or oliguria/anuria) was calculated at various eGFR levels based on g-I/eGFR ratios of 1:2, 1:1, 2:1, and 3:1.
At a g-I/eGFR ratio <1 the risk of CIN was 3%, while it was 25% at a g-I/eGFR ratio >or=1. Independent predictors of CIN were CM dose, eGFR, left ventricular ejection fraction (LVEF) and cardiogenic shock (ROC area =0.87). An estimated CIN risk of 10% would for example occur at a g-I/eGFR ratio of 1.5:1 in patients with 50% LVEF without shock. At a 1:2, 1:1, 2:1, and 3:1 g-I/eGFR ratio with 50% LVEF without shock, the CIN risk was about 2, 6, 18, and 30%, respectively, over a wide range of eGFR values (30-90 ml/min). At a 1:1 g-I/eGFR ratio with 50% LVEF+shock, 25% LVEF without shock, or 25% LVEF+shock, the CIN risk was 20, 55, and 80%, respectively.
Relating CM dose to eGFR appears to be an attractive pharmacotoxic model to assess CIN risk. At fixed CM-dose/eGFR ratios, CIN risk increased marginally with decreasing eGFR. Limiting the CM dose in g I numerically to the eGFR value in ml/min or less may be relatively safe with regard to CIN, unless multiple risk factors are present.
最近有人主张用造影剂（CM）剂量与估算肾小球滤过率（eGFR）的比值来表示CM的全身暴露情况，以评估造影剂诱发肾病（CIN）的风险。
评估在固定的CM剂量/eGFR比值及其他CIN风险因素下，CIN风险如何随eGFR降低而变化，并找到一个相对安全的CM剂量/eGFR比值。
391例患者因ST段抬高型急性心肌梗死接受了急诊冠状动脉血管成形术。将CM剂量（碘克数；g I）、eGFR（ml/分钟）和术前CIN风险因素纳入多元逻辑回归模型。根据已建立的统计模型，基于1:2、1:1、2:1和3:1的g-I/eGFR比值，计算不同eGFR水平下CIN（血清肌酐升高≥44.2微摩尔/升或少尿/无尿）的发生概率。
当g-I/eGFR比值<1时，CIN风险为3%，而当g-I/eGFR比值≥1时，CIN风险为25%。CIN的独立预测因素为CM剂量、eGFR、左心室射血分数（LVEF）和心源性休克（ROC面积=0.87）。例如，在LVEF为50%且无休克的患者中，g-I/eGFR比值为1.5:1时，估计CIN风险为10%。在LVEF为50%且无休克的情况下，g-I/eGFR比值为1:2、1:1、2:1和3:1时，在较宽的eGFR值范围（３０～９０ｍｌ/分钟）内，CIN风险分别约为2%、6%、18%和30%。在LVEF为50%且有休克、LVEF为25%且无休克或LVEF为25%且有休克的情况下，g-I/eGFR比值为1:1时，CIN风险分别为20%、55%和80%。
将CM剂量与eGFR相关联似乎是一种评估CIN风险的有吸引力的药物毒性模型。在固定的CM剂量/eGFR比值下，CIN风险随eGFR降低略有增加。就CIN而言，将g I形式的CM剂量在数值上限于eGFR值（ml/分钟）或更低可能相对安全，除非存在多种风险因素。
