Department of Neurosurgery, National Hospital Organization, Toyohashi Medical Center, Aichi, Japan.
AJNR Am J Neuroradiol. 2011 Mar;32(3):441-5. doi: 10.3174/ajnr.A2344. Epub 2011 Jan 27.
Although many studies have demonstrated that CIN is associated with in-hospital and long-term mortality, the incidence of CIN following CAS is unclear. We investigated the incidence of CIN, defined as an increase from a baseline creatinine value of at least 0.5 mg/dL or 25% within 72 hours of contrast administration, and we also examined renal function in the late phase after CAS.
We examined 80 patients who underwent CAS between April 2005 and December 2009. Clinical background, laboratory data, contrast volume, and clinical course were collected and analyzed.
The incidence of CIN was 8.8% (7/80), and no patients required hemodialysis. In the group that developed CIN, prolonged CSR after CAS was found in 57.1% (4/7) of cases; this incidence differed significantly (P = .001) from that in the group without development of CIN. Neither preoperative renal function, contrast volume, nor history was related to the incidence of CIN, while on multivariate analysis, prolonged CSR was found to be an independent risk factor for CIN. The incidence of elevation in creatinine values at 6 months after CAS was 8.2% (6/73). All patients who developed delayed renal impairment had pre-existing CKD; this finding differed significantly (P = .04) from that in the group without development of delayed renal impairment.
Because patients who develop prolonged CSR after CAS are at increased risk of perioperative major adverse clinical events including CIN, patients at high risk for this condition should be carefully managed to prevent increased morbidity and mortality.
虽然许多研究表明 CIN 与住院期间和长期死亡率有关，但 CAS 后 CIN 的发生率尚不清楚。我们调查了 CIN 的发生率，其定义为在造影剂给药后 72 小时内从基线肌酐值至少升高 0.5mg/dL 或 25%；我们还检查了 CAS 后晚期的肾功能。
我们检查了 2005 年 4 月至 2009 年 12 月期间接受 CAS 的 80 例患者。收集并分析了临床背景、实验室数据、造影剂体积和临床过程。
CIN 的发生率为 8.8%（7/80），无患者需要血液透析。在发生 CIN 的组中，57.1%（4/7）的患者在 CAS 后 CSR 延长；与未发生 CIN 的组相比，这一发生率差异显著（P=.001）。术前肾功能、造影剂体积或病史与 CIN 的发生率均无关，而多变量分析显示 CSR 延长是 CIN 的独立危险因素。CAS 后 6 个月肌酐值升高的发生率为 8.2%（6/73）。所有发生延迟性肾功能损害的患者均有预先存在的 CKD；与未发生延迟性肾功能损害的组相比，这一发现差异显著（P=.04）。
由于 CAS 后 CSR 延长的患者围手术期发生重大不良临床事件（包括 CIN）的风险增加，因此应仔细管理高危患者，以防止发病率和死亡率增加。
