肝细胞癌患者经导管动脉化疗栓塞术后对比剂诱导肾病的发生率及危险因素。
Incidence and risk factors for radiocontrast-induced nephropathy in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization.
机构信息
Department of Internal Medicine, College of Medicine, Gyeongsang National University, 92 Chilamdong, Jinju, South Korea.
Institute of Health Science, Gyeongsang National University, Jinju, South Korea.
出版信息
Clin Exp Nephrol. 2011 Oct;15(5):714-719. doi: 10.1007/s10157-011-0470-9. Epub 2011 Jun 23.
BACKGROUND
Transcatheter arterial chemoembolization (TACE) is an effective treatment for unresectable hepatocellular carcinoma (HCC); however, large volumes of radiocontrast agents are used for TACE and may induce renal dysfunction. Most patients with HCC have coexisting liver cirrhosis (LC) at the time of diagnosis. Advanced cirrhosis is characterized by peripheral vasodilatation associated with decreased renal perfusion due to the activation of vasoconstrictor systems. We retrospectively investigated patients with HCC who had undergone TACE to determine the incidence and risk factors for radiocontrast-induced nephropathy (RCIN).
METHODS
A total of 101 patients with HCC who underwent a combined 221 TACE treatment sessions were included. Follow-up serum creatinine levels within 96 h after TACE were confirmed in these patients. RCIN was defined as an increase of at least 25% in baseline serum creatinine levels between 48 and 96 h after TACE.
RESULTS
RCIN developed in 20 (9%) of the 221 treatment sessions after TACE. A univariate analysis showed that the Child-Pugh score (6.0 ± 1.3 vs. 6.7 ± 1.9, P = 0.005), ascites (14.4 vs. 40%, P = 0.008), contrast medium volume (257.3 ± 66.8 vs. 275.0 ± 44.0 ml, P = 0.009), total bilirubin (1.3 ± 1.7 vs. 3.4 ± 8.0 mg/dl, P < 0.001), basal serum creatinine levels (0.9 ± 0.3 vs. 1.0 ± 0.5 mg/dl, P < 0.001) and glomerular filtration rate using the modification of diet in renal disease formula (90.5 ± 21.8 vs. 88.4 ± 29.6 ml/min, P = 0.015) were significantly associated with the development of RCIN. A multivariate analysis revealed that the Child-Pugh score was associated with RCIN [odds ratio (OR) 1.5; P = 0.015]. Overall, in-hospital mortality after TACE was 4.07% (with RCIN, 30%; without RCIN, 1.5%; P < 0.001). The multivariate analysis also showed that the Child-Pugh score and the occurrence of RCIN were associated with in-hospital mortality after TACE (OR 2.8; P = 0.001; OR 26.7, P = 0.002, respectively).
CONCLUSIONS
RCIN after TACE was closely associated with the severity of LC. Effective preventive measures remain to be determined in patients with HCC and advanced LC who are undergoing TACE.
背景
经导管动脉化疗栓塞术（TACE）是治疗不可切除肝细胞癌（HCC）的有效方法；然而，TACE 中使用了大量的造影剂，可能会导致肾功能障碍。大多数 HCC 患者在诊断时同时患有肝硬化（LC）。晚期肝硬化的特点是外周血管扩张，由于血管收缩系统的激活，导致肾灌注减少。我们回顾性研究了接受 TACE 的 HCC 患者，以确定造影剂诱导的肾病（RCIN）的发生率和危险因素。
方法
共纳入 101 例接受 HCC 联合 221 次 TACE 治疗的患者。这些患者在 TACE 后 96 小时内均确认了随访血清肌酐水平。RCIN 定义为 TACE 后 48-96 小时内血清肌酐水平较基线升高至少 25%。
结果
在 221 次 TACE 治疗后，有 20 次（9%）发生 RCIN。单因素分析显示，Child-Pugh 评分（6.0±1.3 与 6.7±1.9，P=0.005）、腹水（14.4%与 40%，P=0.008）、造影剂用量（257.3±66.8 与 275.0±44.0ml，P=0.009）、总胆红素（1.3±1.7 与 3.4±8.0mg/dl，P<0.001）、基础血清肌酐水平（0.9±0.3 与 1.0±0.5mg/dl，P<0.001）和基于肾脏病饮食改良公式的肾小球滤过率（90.5±21.8 与 88.4±29.6ml/min，P=0.015）与 RCIN 的发生显著相关。多因素分析显示，Child-Pugh 评分与 RCIN 相关[比值比（OR）1.5；P=0.015]。总体而言，TACE 后院内死亡率为 4.07%（RCIN 组 30%；无 RCIN 组 1.5%；P<0.001）。多因素分析还显示，Child-Pugh 评分和 RCIN 的发生与 TACE 后院内死亡率相关（OR 2.8；P=0.001；OR 26.7，P=0.002）。
结论
TACE 后 RCIN 与 LC 的严重程度密切相关。对于接受 TACE 的 HCC 合并晚期 LC 患者，仍需要确定有效的预防措施。
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